Company Information
Company Name:
Web Site: (optional)
Phone:		Fax: (optional)
Street Address:
City:		State/Province:
Zip/Postal Code:		Country:
Primary Contact
Name:		Title:
E-mail Address:
Direct Phone:		Mobile Phone: (optional)
Management Team
Name:		Title:
Name:		Title:
Name:		Title:
Why this team is qualified to build the company?	Please limit your text to less than 250 characters
Company Profile
One-line Pitch:	Please limit your text to less than 150 characters
Year Founded:		Year Incorporated:
Number of Employees:
Do You Have Revenue?	Select -- Yes No	What Revenue or Pre-booked Sales Do You Have?
Forecast 2010 Revenue:		Projected 2010 Sales:
Business Type:		Business Stage:	Select -- Concept Only Product in Development Prototype Ready Full Product Ready $0-$500K in Trailing 12 Mo. Revenue $500K-$1M in Trailing 12 Mo. Revenue $1M-$3M in Trailing 12 Mo. Revenue $3M-$5M in Trailing 12 Mo. Revenue $5M-$10M in Trailing 12 Mo. Revenue $10M-$20M in Trailing 12 Mo. Revenue $20M-$50M in Trailing 12 Mo. Revenue +$50M in Trailing 12 Mo. Revenue
Business Model:	Please limit your text to less than 450 characters
Technology Description:	Please limit your text to less than 250 characters
Product/Service Description:	Please limit your text to less than 450 characters
What (if any) Traffic/Users or Distribution Lined-up Do You Have?	Please limit your text to less than 450 characters
Target Market Information
Who is Your Customer?	Please limit your text to less than 450 characters
Current & Potential Customers:	Please limit your text to less than 250 characters
Known & Potential Competitors:	Please limit your text to less than 450 characters
Competitive Advantages:	Please limit your text to less than 250 characters
Financing Information
Capital Raised to Date:
What (if any) Existing Financing Do You Have?		Financing Currently Sought:
Exit Strategy
Why Do You Think You'll Be Able to Get to an Exit and Which Potential Acquirers Do You Know and Have Talked to?	Please limit your text to less than 450 characters