| Funding Application
Please complete the following application.
Please submit your business
plan to management @ launchfn.com. Once we received all your information, your application will be processed and reviewed.
You will then be contacted with the results in 5 to 7 working days.
Directions:
When selecting more than one item. 
Hold the Ctrl key and select all that apply. Please complete your first name, last name, and
email address. |
| | |
| First Name | |
| Last Name |
|
| Email | |
| | |
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Section A:
If you have already completed LAUNCHfn's Registration Form, please skip this section and proceed to Section
B.
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| How did you hear about us? |
| Please select one Internet Search LAUNCHfn.com website Link from another web site Other (Input Name of referral
source) | |
Name of source
referring you.
(website, person, etc.) | |
| Salutation | | Please select oneMr. Mrs. Dr. Ms. | |
| Job Title | |
| Company | |
| If you are not the president or CEO of the company, then who
is? | |
| Street
Address | |
| Suite or Bldg # | |
| City | |
| State | |
| Zip Code |
|
| Country | |
| Phone no. | |
| Cell
phone | |
| Fax no. | |
| Website | |
| What industry is the company in? | | Please
select oneBio-Medical Services Consumer Products Real Estate Distribution/Transportation Entertainment/Media Franchise/Retail
Homeland Security Government Mining/Minerals/Petroleum Manufacturing Technology Software Telecom/Wireless Internet Other | |
| What is your legal structure? |
| Please select oneNot Incorporated LLC S Corp C Corp | |
| What is the stage of the company? | | Please select oneSeed
stage (Proof of concept) Start up stage (Ready to Launch) Early stage (Sales under $500000) Expansion stage (Sales $500000
to $3000000) Late stage (Sales > $3000000) Buy-out or Acquisition IPO stage (Sales > $25000000) | |
| How many years has the company been in business? |
|
| Describe
the business in 200 words or less. | |
| Who is the company's target or demographic market? | |
| What are
the company's current revenues? | |
Is the company cash flow positive?
|
|
Is the company profitable?
| |
| What was last year's revenue? |
|
| What is your total past revenue? | |
| What is the forecast for
next year's revenue? | |
| How much capital is the company seeking? | |
| What type of capital is the company seeking? | | Please select all that apply
Unsure Purchase Order or Contract Financing Working Capital Loan / SBA Active Investor 'Exec with Check' Private Investor
(Angel) Venture Capital PIPE - Micro IPO | |
| What types of services is the company seeking? | | Please select all that apply Investor events Investor relations campaign
Business plan services Loan facilitation Strategic planning Capital funding strategy Investor document preparation Other | |
| How much have the founders invested in the company? |
|
| What is the total amount invested in the company? | |
| Does the company have a PPM? |
| Please select
oneYes No Partially complete Have investor term sheet | |
| Does the company have a business plan? | | Please select oneYes No Partially
complete | |
| Does the
company have a investor presentation? |
| Please select oneYes No Partially complete | |
Section B:
|
| Do you have an executive summary? | Please select oneYes No
Partially Complete |
| What is the company's EIN or CEO/founder's
SS#? | |
| Briefly
list current management names and relevant industry experience. | |
| How many current customers does the company have? | |
| How
many pending customers does the company have? | |
| How will the company use the funds? | |
| What is
the minimum amount of funds needed to reach the company's next milestone? |
|
| What portion of the funds can be taken as
debt? | |
| What is the company's current debt? |
|
| For loan applications, if the founders credit
scores are below 650, do you have a shareholder who can co-sign? | | Please select oneYes No Maybe | |
What is the value of the company's total
real estate holdings? |
| Please select oneUp tp $500,000
$500,000 to $2 Million $2 million or More | |
| Describe how the company sells and delivers products or services to the market. | |
| Describe your marketing strategy to create brand awareness
and gain market share. | |
| Is your product patented, or patent pending? |
|
What makes the company unique and different
from the
competition? | |
Name
3 competitors and 1 advantage your
company has over them. | |
| Name the company's key milestones. | |
Name the
board of advisors and their key
value to the company. | |
Name any strategic alliances or joint ventures
with the
company. | |
Describe your staff structure and what are
their functions. | |
| Choose the statement(s) you
have ready. | |
Please select all that apply Current Balance Sheet Current Income Statement Operating Budget Cash Flow Analysis Breakeven
Analysis Forecast | |
List
insurance policies and their value
(such as Key Man, Buy Sell, Error and Omissions, etc.) | |
Does your
company have any pending litigation,
if yes please explain?
| |
| Does your company have the sales process documented and a sales
training program? |
| Please select oneYes No Partially Complete | |
| |
| Please
email your business plan (including executive summary), financials, investor presentation (if available) to management@launchfn.com. We prefer Microsoft Office documents. |
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