Innovation Intake Questionnaire:

Question Title

* 1.
Tell us about yourself.

Your Name

Company Name

Company Address 1

Company Address 2

City/Town

State/Province

Zip/Postal Code

Country

Email Address

Phone Number:

Question Title

* 2.
What is, or will be, the URL for your website?

Question Title

* 3. In which industry do you work?

Question Title

* 4.
Product or Service Description:

Question Title

* 5. Business Description: Please provide a clear, complete, and succinct explanation of your company.

Question Title

* 6.
Business Model: Please describe how your company makes money, including distribution channels.

Question Title

* 7.
Ask & Offer: How much new capital do you need to get your venture to positive cash flow and to profitability?

Question Title

* 8.
Ask & Offer: Are you seeking equity or debt financing?

Equity

Debt

Combination of Equity and Debt

Not sure

Innovation Intake Questionnaire:

Question Title

* 1.
Tell us about yourself.

Question Title

* 2.
What is, or will be, the URL for your website?

Question Title

* 3. In which industry do you work?

Question Title

* 4.
Product or Service Description:

Question Title

* 5. Business Description: Please provide a clear, complete, and succinct explanation of your company.

Question Title

* 6.
Business Model: Please describe how your company makes money, including distribution channels.

Question Title

* 7.
Ask & Offer: How much new capital do you need to get your venture to positive cash flow and to profitability?

Question Title

* 8.
Ask & Offer: Are you seeking equity or debt financing?

Question Title

* 9. Ask & Offer: What are you offering the investor for the equity or debt provided? Percentage of company? Interest rate?

Question Title

* 10.
Ask & Offer: How will the investor get their money out? Exit strategy?

Question Title

* 1. Tell us about yourself.

Question Title

* 2. What is, or will be, the URL for your website?

Question Title

* 3. In which industry do you work?

Question Title

* 4. Product or Service Description:

Question Title

* 5. Business Description: Please provide a clear, complete, and succinct explanation of your company.

Question Title

* 6. Business Model: Please describe how your company makes money, including distribution channels.

Question Title

* 7. Ask & Offer: How much new capital do you need to get your venture to positive cash flow and to profitability?

Question Title

* 8. Ask & Offer: Are you seeking equity or debt financing?

Question Title

* 9. Ask & Offer: What are you offering the investor for the equity or debt provided? Percentage of company? Interest rate?

Question Title

* 10. Ask & Offer: How will the investor get their money out? Exit strategy?

* 1.
Tell us about yourself.

* 2.
What is, or will be, the URL for your website?

* 4.
Product or Service Description:

* 6.
Business Model: Please describe how your company makes money, including distribution channels.

* 7.
Ask & Offer: How much new capital do you need to get your venture to positive cash flow and to profitability?

* 8.
Ask & Offer: Are you seeking equity or debt financing?

* 10.
Ask & Offer: How will the investor get their money out? Exit strategy?