Client Application

Questions marked with an asterisk require an answer to proceed.
Please complete all dollar values in whole numbers with no symbols ($1,000 would be completed as 1000.)

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* 1. Applicant Information (Not Business Information)

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* 2. Have you formally established a company? (If NO, please proceed to question 7.)

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* 3. Business Information 

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* 4. What year was the company established? (example: 20xx)

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* 5. What is your company structure?

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* 6. Company Website (http://www.xxxx) Paste link if available.

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* 7. Please describe your product or concept.

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* 8. Product Development Stage. (Select the one that is closest to your current stage of development.)

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* 9. Total number of meetings with potential investors.

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* 10. Total investment capital raised to date. 

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* 11. Investment capital raised through loans.

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* 12. Investment capital raised through grants including Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) grants.

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* 13. Number of Small Business Innovation Research (SBIRs) grants received.

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* 14. Number of pending Small Business Innovation Research (SBIR) applications.

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* 15. Gross sales for most recently completed fiscal year.

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* 16. Gross sales over the lifetime of the business.

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* 17. Current number of employees.

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* 18. Number of patents held.

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* 19. Number of patent applications in process.

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* 20. Number of new product launches to date.

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* 21. How did you learn about IPDC?

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* 22. Please attach any documents you would like IPDC to review with your application.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

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* 23. Please attach your company logo, if available.

PNG file types only.
Choose File

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* 24. Would you like your company to appear on the IPDC website? 

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* 25. Please list any incubator and/or entrepreneur programs for which you are a member.

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* 26. Please list any company social media sites.

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* 27. Additional Comments:

T