Company Name
Company Website
Company Zip Code
First Name
*
Last Name
*
CEO
President
Email
*
Phone
Describe Your Business
What is unique about your product or service?
What is your main objective during the next 12 months?
What are the main things holding you back from growth and expansion?
What services, besides capital, do you require to grow your business?
Please complete the following sections if you seek growth capital: Money To Be Raised
Pre-Money Valuation
Industry
Annual Market Revenue
Your Current Annual Revenue
Management Experience (1 low - 10 high)
Select an option
1
2
3
4
5
6
7
8
9
10
Board of Directors?
Select an option
TBD
Yes
No
Board of Advisers
Select an option
TBD
Yes
No
Have You Raised Money in the Past
Select an option
TBD
Yes
No
If "Yes" How Much
Do You Have a Business Plan
Select an option
TBD
Yes
No
How Did You Hear About The Arizona Collaboratory