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Company Name:
Contact:
Title:
Phone:
Email:
Business Summary:
   
Do you have a business plan? Yes
No
   
Does/Will your company provide a product or a service? Product
Service
 
What are the company's current financial needs?
   
How have you financed your company to date? Personal Savings
Friends & Family
High Net Worth Individuals (Angels)
Venture Capital Firms
IPO
Corporate/Stratgegic Investors
Equipment Leasing
Bank Loans
Subordinated Debt
Is the Management Team in place? Board of Directors
CEO, President or COO
CFO or Controller
VP Technology
VP Marketing
   
What is the make up of your Board of Directors? Founders/Management
Friends & Family
Investors
Other Outsiders
   
What industry/market is your company targeting? (Check all that apply) Internet
Software
Health Care
Semiconductor
Telecommunications
Consumer
Product
Service
   
Tell us about cash:  
Burn Rate Per Month: Positive Cash Flow
Less than $100,000
$100,000 to $249,999
$250,000 to $499,999
Over $500,000
Cash Reserves: 19 months or longer
13-18 months
7-12 months
4-6 months
3 months or less
Time to Positive Cash Flow:
Less than 6 months
7-12 months
13-18 months
19-24 months
25 months or longer
   
Financial History and Projections:  
Most current year end results:
$6,000,000 +
$2,000,000 - $5,999,999
$500,000 - $1,999,999
$0 -$499,999
   
This year projected:
$6,000,000 +
$2,000,000 - $5,999,999
$500,000 - $1,999,999
$0 -$499,999
   
Projections at end of year five:
$6,000,000 +
$2,000,000 - $5,999,999
$500,000 - $1,999,999
$0 -$499,999
   
Cash on hand:
$1,000,000 +
$200,000 - $999,999
$1 - $199,999
   
Cash flow positive in:
24 - 36 months
12 - 23 months
6 - 12 months
within 6 months
   
What type of assistance does your company need?
   
How big is your target market in dollars?
   




 

 

 

 

 

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