Company Information
Company Name‡  
Street Address‡  
City‡  
State/Province  
Zip/Postal Code  
Country‡  
Region  
U.S. Phone    (Include Country/Area Code)
International Phone (non-U.S. companies)    (Include Country/Area Code)
Web Site/URL  
Contact Information
First Name‡  
Last Name‡  
Title‡  
Email Address‡  
Direct Phone (if different from above)    (Include Country/Area Code)
International Phone (if different from above)    (Include Country/Area Code)
Business Information
Date Founded   (ex: mm/dd/yyyy)
Development Stage‡  
Business Sector‡  
Business Description‡   Concisely describe what the company does, what problem you are solving
and your value proposition. (500 character limit — 10 lines)

Product/Service‡   Briefly describe the products/services offered by the company. (500
character limit — 10 lines)
Market/Industryy‡   Describe the industry, who does your company sell to? Through what channels?
How big is the addressable market? (750 character limit — 15 lines)

Revenue Modell‡   Very briefly describe the revenue model for the company. (250 character
limit — 5 lines)

Customer/Partner Overview   What key customer or partner relationships do you have? (750 character
limit — 15 lines)

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)

Competitive Advantage and Intellectual Property‡   Describe your competitors, your differentiation, and your competitive
advantage (patents, tradenames, etc. ). (1000 character limit — 20 lines)

Other  
Funding Information (no abbreviations please)
Amount Sought‡   (U.S. $ in millions) Total financing being sought now
PreMoney Valuation‡   (U.S. $ in millions) Total financing being sought now
Current Round  
Planned Use of Funding‡   How do you plan to use funding from this round? How long will it last?
(1000 character limit — 20 lines)

Prior Funding History‡   Describe how much money the company has raised to date, when, and
from whom. (1000 character limit — 20 lines)

Current Investors‡  
Recent Financial History and Forecasts ($ U.S.)
 
U.S. $ (in millions) Previous Year Current Year In Five Years
Revenues ($) $ $ $
Net Income ($) $ $ $
Headcount         
‡ Required Field