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Please fill out the e-application below. It is very simple to fill out, especially if you have a well-written executive summary or business plan! You can cut and paste from your summary, and type new information in less than 20 minutes. Use concise bullet points as often as possible to respond to the questionnaire below.

At the end of this application form, you will be asked ot submit an application fee.

1. Your Information:
a. Last Name:
b. First Name:
c. Company Name:
d. Title:
e. Email:
f. Phone Number:
g. Address:
h. City, State, Zip:
i. Fax:
2. What stage are you in? Please choose from the following:
3. What stage of funding are you looking for? Please choose from the following:
4. a. How much money have you raised so far?
b. How much money are you raising?
c. How long will the money last?
d. And, list the use of proceeds.
5. One sentence elevator pitch and one sentence value proposition (Maximum 500 characters).
6. a. Management Team Experience and Credentials (Maximum 5000 characters)
b. List your Advisors and Board Members with details about their experience and credentials (Maximum 5000 characters)
c. Key Positions to fill in the next 12 months (Maximum 1000 characters)
7. The Challenge - what is the problem you are solving? (Maximum 3000 characters)
8. Your Solution - what is your business model? (Maximum 3000 characters)
9. Market Opportunity - What is your market size? And, name the source of your declared number. (Maximum 1500 characters)
10. a. Target Market #1 — List the market drivers — what is driving them to buy your product/service? (Maximum 2000 characters)
b. Target Market #2 — List the market drivers — (Maximum 2000 characters)
11. Competition — List their name and then give your differentiating factors, barrier to entry, and how are you better?
Competition 1.
Competition 2.
Competition 3.
Competition 4.
Competition 5.
12. At what month and year (xx/yyyy) do you anticipate becoming profitable?
(Maximum 7 characters)
13. Revenue Model - How will you make money? (Maximum 3000 characters)
14. List milestones achieved. Extra Credit, 10 pts! (Maximum 2000 characters)
15. Customers and Revenues. Extra Credit, up to 25 pts! (How much are they paying, if any?).
Customer 1.
Customer 2.
Customer 3.
Customer 4.
Customer 5.
Total annual revenues to date ($)






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