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?*