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Applicant Information
We will use this information to contact you
First Name
*
Last Name
*
Role
*
Founder
Co-Founder
President
VP
CEO
CTO
COO
CIO
Other
Work Email
*
Phone Number
*
Role (if chose other)
Company Information
Let's get some information about your exciting startup
Company Name
*
Company Type
*
C Corp
S Corp
LLC
Sole Proprietorship
Wholly Owned Subsidiary
Non Profit
Unincorporated
Other
Company Website
*
State Incorporated In
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
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New York
North Carolina
North Dakota
Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Incorporated in another country
Not Incorporated
Company Type (if Chose other)
Please indicate the Company Type if chose other.
Next
Describe Your Startup
Tell us about your cool startup and what it does
One Line Description Of Your Startup
*
Number of Employees
*
Which Technology Vertical Do You Fall Under (Pick All That Apply)
*
FineTech
Payments
Commerce
Cyber Security
IT Infrastructure
Cloud Computing
Blockchain - Distributed Ledger Tech
Web 3
Crypto
Gaming
Hospitality Innovation
HealthTech
Telemedicine
Video Games
Ed Tech
Clean Tech
SaaS
Funding Status
Are there folks out there that believe enough in you to put some money into your startup?
Have you Raised any Funding?
Yes
No
How much Funding Have You Raised (In USD)
*
What Stage Of Funding Are You In?
Pre-Seed
Seed
Series A
Series B
Series C
Next
Describe Your Startup Experience
Description (Optional)
Is This Your First Startup?
I Have Been A Founder Before
I Have Been Part Of The Early Team At A Startup
I Have Never Been At A Startup
Name of Your Previous Startup(s)
*
Status Of Your Previous Startup(s) [check all that apply]
*
Acquired
IPO
Merged
Ongoing
Shutdown
Anything Else You Want Us To Know
What Did We Miss? Tell Us More …
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