Company Profile Form

Early Capital regards most submitted information as confidential, if you have any further questions please see our Privacy Statement. After this form is completed you will have the option to send a corresponding business plan or private placement memorandum, if one is available.

The form covers most business aspects of an emerging company. Please review the entire form below before proceeding, to ensure the information being requested is readily available. Some fields may appear too brief to encompass all the information, in which case, a short and focused answer will suffice.

While brevity is important, please answer all questions to the best of your knowledge. Please set aside about five minutes to complete this form.
  1. Contact Information (* required field)
1.1 *Company 
1.2 *First Name (contact)
1.3 *Last Name (contact)
1.4 *Title (or relationship to company)
1.5 *Street Address
(Company)
1.6 *City
1.7 *State/Province/Territory
1.8 Zip Code 
1.9 *Country
1.10 *Phone
1.11 *Contact Email
1.12 Company URL
1.13 How did you learn
about Early Capital? 
     
  2. General Information

2.1
*Briefly describe the company's main product/service?

2.2
*Please designate the company's industry sector.

2.3
*Please designate the company's current stage of development

2.4
*Please designate the legal description of the company.

2.5
*When was the company incorporated?
month
year

2.6
*Where was the company incorporated?
State/Province/Territory
Country

2.7
*Briefly describe what problem or need your product/service is solving.
     
  3. Market
3.1 *Estimate the size of the company's potential market (annual sales).

US domestic
International (non-US)

 $ USD
$ USD
3.2
*Does the company currently have paying customers/clients?

Yes
No
3.3
*Briefly describe the company's three primary competitors.
a.)
   
b.)
   
c.)
3.4
*Please approximate the market share (%) held by each of the above competitors.
a.) %
   
b.) %
   
c.) %
3.5
*Briefly explain what competitive advantages the company has over its primary competitors.
     
  4. Intellectual Property
4.1 *Does the company have any intellectual property?

Yes, patents issued
Yes, patents filed (pending)
Yes, trademarks

Yes, copyrights
Yes, licenses
No
4.2 If applicable, briefly describe any intellectual property mentioned in 4.1 above.
     
  5. Finance
5.1
*Briefly describe the company's primary source of revenue.
5.2
If applicable, please approximate your gross revenues during the last 3 months.

$ USD
5.3
* After completing the current round of capital raising, when do you project your company will be profitable (projected break-even date)?

0 to 6 months
6 to 12 months
1 to 2 years

2 to 4 years
5+ years
5.4
*Please designate which round of financing your company is currently pursuing.

Seed
First
Second

Third
Fourth
Other

5.5 *How much equity capital is the company currently seeking?

$ USD
5.6
*What is the largest sum of investment capital that has been managed directly by your company's officers in the past?

5.7
*Approximately, how much capital has been raised to date?

$ USD
5.8
*Briefly describe your capital raising efforts to date.
     
  6. Development
6.1 *Please describe the current stage of development for your company's product/service.

R&D
Beta-testing
Generating revenue

6.2 *Do you have a demo, beta or prototype version of your product/service?

Yes
No
N/A

6.3 Briefly describe recent notable milestones achieved by your company.
6.4 *How many full-time (30+ hrs per week) employees do you have on payroll?

6.5 *How many individuals from your company's management have more than five years of sector experience:

6.6 *How many individuals in your company dedicate at least 30 hours per week to company related tasks?

6.7 *How many company officers have served as management of other startup or early stage ventures?

6.8 Please describe any regulations, laws or statutes that may hinder or facilitate the development of your company?
     
  7. Projections
7.1 *Briefly describe your company's current or potential customers.
7.2 *In what time frame do you plan to execute your company's investor exit strategy?

0 to 12 mo.
13 to 23 mo.
2 to 3 yrs.

3 to 5 yrs.
5+ yrs.
N/A
7.3 *What is your planned exit strategy for your company's investors?

Acquisition/Merger
IPO
Other

Once the form has been entirely completed, submit the information by pressing the button below. Optional instructions on sending a business plan will follow.

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