| Company Information |
| ‡Company Name |
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| ‡Street Address |
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| ‡City |
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| ‡State/Province |
If not in list, enter here: |
| ‡Zip/Postal Code |
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| Country |
If not in list, enter here: |
| ‡Region |
If not in list, enter here:
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| ‡U.S. Phone |
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| ‡International Phone (non-U.S. companies) |
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| Web Site/URL |
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| Contact Information |
| ‡Name |
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| ‡Title |
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| ‡Email Address |
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| Direct Phone (if different from above) |
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| International Phone (if different from above) |
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| Business Information |
| Date Founded |
(ex: mm/dd/yyyy) |
| ‡Development Stage |
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| ‡Business Sector |
Choose the sector that best fits your business.
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| ‡Business Description |
Concisely describe what the company does, what problem you are solving and your value proposition. (500 character limit — 10 lines)
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| ‡Product/Service |
Briefly describe the products/services offered by the company. (500 character limit — 10 lines)
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| ‡Market/Industry |
Describe the industry, who does your company sell to? Through what channels? How big is the addressable market? (750 character limit — 15 lines)
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‡Revenue Model
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Very briefly describe the revenue model for the company. (250 character limit — 5 lines)
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| Customer/Partner Overview |
What key customer or partner relationships do you have? (750 character limit — 15 lines)
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| ‡Management Team and Board of Directors/Advisors |
Describe positions, background, and expertise. For each person, enter name, role, past companies, years in industry (1000 character limit — 20 lines)
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| ‡Competitive Advantage and Intellectual Property |
Describe your competitors, your differentiation, and your competitive advantage (patents, tradenames, etc. ). (1000 character limit — 20 lines)
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| Other |
Anything else we should know? (If you were referred to us, please include a detailed explanation here). (200 character limit — 4 lines)
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| Funding Information (no abbreviations please) |
| ‡Amount Sought |
(U.S. $ in millions) Total financing being sought now |
| ‡PreMoney Valuation |
(U.S. in millions) Estimated valuation prior to any new funding |
| ‡Current Round |
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| ‡Planned Use of Funding |
How do you plan to use funding from this round? How long will it last? (1000 character limit — 20 lines)
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| Prior Funding History |
Describe how much money the company has raised to date, when, and from whom. (1000 character limit — 20 lines)
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| ‡Current Investors |
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| Recent Financial History and Forecasts ($ U.S.) |
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