Incubator Program Application

Name

First Name

Last Name

Company Name

Email Address

Website

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Legal/Corporate Business Name if established or d/b/a:

Type of Business

Country In Which Business is Licensed

List all owner(s) of the business or Major Shareholders, % owned and contact information for each.

Please list Management/Leadership - including Chairman/Woman of the Board, President, CEO, Key Management Members, Governing/Advisory Bodies

Development

Year product(s) or services(s) introduced?

Stage of business formation. Do you have any of the following completed or in progress 1) Completed Business Plan or Business Canvas Model 2) Completed business formation 3) Financial Pro-Forma 3) Marketing Strategy. Please let us know the status of each.

Progess of current plans:

Past milestones & successes (if applicable)

Financial Status (Please Provide Applicable Information)

Last Years Total Sales

Last Years Total Profit

Amount of Funds Sought

Use of Funds Sought

Products & Services

Please describe your Product/Service

Number & Types of Product Lines

Patents & Licensing

Patents Held or Pending

Licenses Held or Pending

Space or Desired Use Requirements

My Space Needs Include:

Premium Tenant - Enclosed Glass Front Office & Incubator Program(s) Access‎

Incubator Resident - Dedicated Work Space & Incubator Program(s) Access‎

Virtual Tenant - Incubator Program(s) Access with limited use of conference areas‎

Co-Working - Flexible Drop-In (any work space) during business hours with no incubator program(s) access‎

Expected Start Date

Message

Become an incubator client & grow your start-up