The Pitch Contest Form

    Basic Information

    Title

    Full Name*

    Company Name*

    Job Title*

    Address*





    Phone Number*

    Cell Phone Number

    Email Address*

    Website

    How did you hear about us?

    I was asked to fill out this form be a person at:

    If you choose other for the last question, please specify here

    About Your Business Idea

    Industry Categorization*

    Provide a brief summary of your company/product/idea. Please indicate what is unique: (100 words or less)*

    How much cash has been invested in the business to-date?*

    Please indicate sources of investment(s): (check all that apply)

    Owner / FounderVenture CapitalGrantsSales RevenueFriends and FamilyLoansAngelsNoneOther

    If you checked "other" in the last question, please specify here:

    Are you interested in pursuing a high-growth business strategy which may involve raising money from outside sources, including venture capital and other funds?*

    YesNoNot Sure

    Are you aware that taking outside capital will result in decreased equity?*

    YesNoN/A

    Is your company minority-owned or managed?*

    YesNo

    If yes, please specify Minority Group

    Is your company women-owned or managed?

    YesNo

    Including yourself, how many full-time employees work for the company?*