APPLICATION FORM

Please fill out the following form to the best of your ability. Our team will be sure to get back to you in a timely manner.

Company name

Website

CEO first name

CEO last name

Phone number

Country

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How did you hear about us?

HQ location

Year founded:

Primary social or environmental impact

Revenue model

Last year's revenue

Aggregate of last three month's revenue

Number of full time employees

Number of paid customers

Value of new sales signed last month

Amount raised to date

Monthly net burn (3 month average)

Cash on hand

Size of current raise

Valuation

Terms

Most likely exit and timing

Competitors

Most impressive points

Biggest concerns

One milestone prediction next 6 months

Link to your investor deck