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Step2: Registration
Form
Thank you for your payment!
It is very important that you complete the following information in order to
accelerate your funding process. After submitting the registration form, a capital consultant will contact you shortly.
Directions:
When selecting more than one item.
Hold the Ctrl key and select all that apply.
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| How did you hear about us? |
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Name of source referring you.
(website, person, etc.) |
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| Salutation |
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| First Name |
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| Last Name |
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| Email |
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| Job Title |
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| Company |
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If you are not the president or CEO
of the company, then who is? |
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| Street Address |
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| Suite or Bldg # |
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| City |
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| State |
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| Zip Code |
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| Country |
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| Phone no. |
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| Cell phone |
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| Alternate phone no. |
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| Fax no. |
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| Website |
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| What industry is the company in? |
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| What is your legal structure? |
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| What is the stage of the company? |
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| How many years has the company been in business? |
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| Describe the business in 200 words or less. |
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Who is the company's target or demographic market?
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What are the company's current revenues?
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Is the company cash flow positive?
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Is the company profitable?
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| What was last year's revenue? |
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| What is your total past revenue? |
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| What is the forecast for next year's revenue? |
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| How much capital is the company seeking? |
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| What type of capital is the company seeking? |
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| What types of services is the company seeking? |
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How much have the founders invested in the company?
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| What is the total amount invested in the company? |
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| Does the company have a PPM? |
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| Does the company have a business plan? |
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| Does the company have a investor presentation? |
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How long did it take you to complete
this form? |
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| Comments |
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