1.
Company
name :
2.
Indicate if:
select one
Corp
S Corp
LP
LLC
partnership or sole proprietorship
in formation
3.
Company street address:
Actual physical office location
4.
Company street address line 2:
Added address and suite if applicable
5.
Company city:
6.
Company state:
select one
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
7.
Company zip:
9 digit if known
8.
Company phone:
xxx-xxx-xxxx + ext
9.
Company web site:
Full URL
10.
Contact person:
Person that we can contact at company
11.
Contact title:
(CEO, CTO, chief engineer, chief medical officer, etc.)
12.
Contact email:
Direct email to contact person
13.
Contact office phone:
Direct office telephone number of contact person
14.
Contact cell phone:
Direct cell phone number of contact person
15.
Business description:
What functions does your company perform to create value and
generate revenue?
Check those that apply
invent
design
develop
manufacture
test
market
support and service
distribute
16.
What is your product or service?
One sentence description
e.g. semiconductor devices, software and systems for Terra
Hertz rate supercomputers targeting selected vertical marketing
applications (Preferred in the form of a Geoffrey Moore style
positioning statement)
256 characters max.
17.
First product(s) to be sold by company:
Brief description of product in no more than 20 words (e.g.
Supercomputer and software for dynamic mechanical simulation)
200 characters max.
18.
Key competitors for your first product(s):
Names of 3 to 5 companies
200 characters max.
19.
Unique differentiation vs. competition:
e.g. unlike <competitor A, competitor B, etc.>, our
products allow customers to commit to new vehicle designs
enabling new vehicle development without building prototypes.
200 characters max.
20.
Which of the following technologies apply to your core intellectual
property?
Check those that apply
life science technology
health care delivery
environmental
energy
distribution methods and channels
information delivery methods
advanced materials
tools and/or equipment
software
semiconductors
electronics and electronic systems
signal processing and algorithms
other information technology
other:
21.
Market sector of major customers:
select one
information technology
life science
energy
advanced materials
wholesale distribution services
financial services
other services
retail
e-business
tools and equipment
environmental
other
22.
Concise description of target customers:
e.g. military and commercial aircraft manufacturers and automobile
and truck manufacturers
200 characters max.
23.
Key benefits to customers:
e.g. enables our customers to achieve accurate and precise
simulations of new vehicle designs with dynamic simulation
of ride and handling.
200 characters max.
24.
Names of Corporate Alliance Partners:
Companies with which you have agreements for product development,
suppliers,
co-branding/marketing/distribution, license or other agreements,
vendor finance arrangements, etc.
200 characters max.
25.
Market Size:
Estimated total size of market to be addressed. With 100%
of the market buying your product, how big would that be?
select one
Less than $10 million
$10 million to $50 million
$50 million to $250 million
$250 million to $1 billion
more than $1 billion
26.
Product Price:
Average selling price for initial product (in dollars)
27.
Current Product development stage:
Pick one:
select one
concept
design complete with documentation
proof of concept demo complete
working prototype
beta unit at customer(s)
production units ready for sale
production units sold and paid for
product units sold and paid for by 3 or more customers
28.
Total equity investment to date:
Total cash $
29.
Date of most recent equity investment:
30.
Total debt / borrowing to date:
31.
Date of most recent debt / borrowing:
32.
When first cash was put into company:
Month and year
33.
Cash currently sought:
(in dollars)
34.
What round of funding are you seeking in this round?
select one
Concept
Seed
A round
B round
C round
D round
Mezzanine
35.
Intended use of new cash investment:
200 characters max.
36.
Team:
CEO:
max. characters: 50
CTO:
max. characters: 50
CFO:
max. characters: 50
VP Marketing:
max. characters: 50
VP Sales:
max. characters: 50
VP Engineering:
max. characters: 50
37.
Person referring startup to Alameda if any:
38.
Referring person's phone if any:
39.
Entity to which referring person is affiliated if any:
Name of company, bank accounting firm, law firm, etc.
40.
Comments:
Add any critical data or instructions that has not been included
in any other item above.
256 characters max.
41.
One sentence non-confidential description of your business (optional)
Do not exceed the limit of 120 characters
e.g. Integrated bio-chemical sensor systems for use in the
battlefield and then in traditional health care testing.
128 characters max.