| Company Name: | |
| Your name and company: | |
| Company Address: | |
| Company Address 2: | |
| Company Phone: | |
| Your e-mail address: | |
| Why are you interested in the HACED Incubator?: | |
| How did you hear about us?: | |
| Business: Describe the product or services your business provides (or plans to provide): | |
| Who will buy (or currently buys) your product or service?: | |
| Is this a local, domestic or international marker?: | |
| Competition: Why will customers buy your product or service instead of the competitor's?: | |
| People: Who makes up your current management group and what is their relevant experience?: | |
| How many current employees do you have?: | |
| Status: What stage is your company at? (ie. concept only, prototype or beta, some revenue, rapid growth): | |
| Is your company presently under lease at some other facility?: | |
| Finances: How have you funded your business to date?: | |
| Do you have funding in place for at least the next 6 months?: | |
| Will you need to raise money before entering an incubator facility?: | |
Please check the items you need:
| Office Space |
| | Modular workstation rental |
| | Telephone service with voicemail |
| | T1 Internet access |
| | Hosting |
| | Computer network installation |
| | Ongoing support |
| | Shared break rooms |
| | Shared conference rooms |
| | Entrepreneur's education programs/seminars |
| | Business plan review/critique |
| | Business advice/brainstorming |
| | Monitoring business progress |
| | Referrals/Contacts |
| | Networking opportunities |
| | Financing equity consideration |
| | Advice/Contacts |
| Comments: | |
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