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On-line Inquiry Form
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| 8 December, 2014 |
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i2E Inquiry
To inquire about i2E advisory services, begin consideration for i2E’s Venture Assessment Program, or to inquire about funding through one of the i2E Investment Programs, please complete the information below. A representative from i2E will contact you to discuss eligibility.
Contact Information: Primary
Contact Information: Primary
*
First
Last
Job Title: Primary
*
Phone Number: Primary
*
Alternate Phone Number
Email: Primary
*
Is there a co-founder or secondary company representative who will be working with you?
Yes
No
Contact Information: Secondary
Contact Information: Secondary
First
Last
Job Title: Secondary
Phone Number: Secondary
Email: Secondary
Company Information
Company Name
*
Company Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
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Iowa
Kansas
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Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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New Hampshire
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New York
North Carolina
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
County (if known)
New or Existing Business?
*
New
Existing
Entity Not Yet Formed
Date of Incorporation
Company Structure
Sole Proprietor
Partnership
LLC
C Corporation
S Corporation
Number of Employees
*
Industry
*
BioTech/Pharma
Consumer Goods
Energy & Environmental
Healthcare Services, Systems & Devices
Manufacturing
Software/Information Technology
Other
How did you hear about us?
*
Client
Internet Search
Investor
Media
OCAST
Other State Agencies
Service Provider
The Alliance
University
Other
How did you hear about us- Other
Eligibility
Location
*
We only work with private companies that have at least 50% of employees and/or assets located in Oklahoma. Is the company located in Oklahoma?
Yes
No
IP
*
If the company relies on intellectual property ("IP") such as patents or trademarks for its competitive advantage, does the company (versus an individual) own or have an exclusive license(s) to the IP?
Yes
No
High Growth
*
Is the company pursuing a high-growth business strategy, as demonstrated by compound growth rates for sales and employment, which may require outside investment?
Yes
No
Business Overview- Market Problem and Solution
Please answer the following questions to the best of your ability. Each response should be limited to 1000 characters or less. DO NOT INCLUDE ANY CONFIDENTIAL OR PROPRIETARY INFORMATION.
Which of the following best describes your business?
*
Concept- an idea for a business with no current revenue or customers
Proof-of-concept- a business with a few initial customers or a company with a prototype
Established Business- a business earning revenue and seeking growth
Is the business already selling goods or services?
Yes
No
If the company is selling goods or services, what was the company’s total revenue for the past twelve months?
Do you have a completed prototype or have you demonstrated the concept?
Yes
No
Is the company minority-owned?
*
Yes
No
If yes, what type?
African American
Native American
Latin American/ Hispanic
Asian-Indian, Asian-Pacific, Pacific Islander
Other
Is the company woman-owned?
Yes
No
Describe your product or service and how it solves a market problem or unmet need (value proposition).
Describe the next steps that must be achieved to move your company forward, including expected timing for each step (one month, six months, one year, etc).
How can i2E help? (Venture Assessment Program, Advisory Services, Debt or Equity Funding Consideration)
Describe the unique intellectual property associated with the company, if any (patent pending, patent licensed, patent issued, algorithms, trademarks, etc).
Describe the qualifications of the team members (industry experience, technical skills, etc).
What risks have you identified to your company’s success?
Investment Status
How much cash (both from founders and investors) has been invested in the business or technology development to date?
Is the business actively seeking outside investment?
*
Yes
No
How much investment are you seeking?
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