Indiana Venture Center




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Please complete this Business Profile and keep all responses to two paragraphs or less. STOP! Before completeing this profile, please make sure you have read the Indiana Venture's Center's criteria for eligible companies. Complete this profile ONLY if your company meets ALL of these criteria.

The Company

Company Name:*
Contact person:*
Address:*
City/State/Zip:*	//
Phone Number:*
Fax:
Email:
Web Site Address:

Lead Entreprenuers and/or Partners

Name:
Title:
Phone:
Email:
Highest Education Received: High School College Graduate School
Past Startup and Business Experience:


Name:
Title:
Phone:
Email:
Highest Education Received: High School College Graduate School
Past Startup and Business Experience:


Name:
Title:
Phone:
Email:
Highest Education Received: High School College Graduate School
Past Startup and Business Experience:

Company Overview

Business Structure:
Business Not Yet Formed C Corporation Proprietorship Limited Liability Company Partnership Sub S Corporation Other
Year Established:
What stage is your company at? Conceptual Prototype Ready For Launch Growth Product / Service Revision
Do you have a business plan? Yes (Please send Business Plan via e-mail) No
State the mission for the company.
Briefly describe your company history and operations.
Briefly describe your product and/or service offerings. How are they unique?
Do you have any intellectual property protection, such patents, trademarks, copyrights?
If this is a life sciences company, will you need FDA Approval? Yes No
If yes, where do you stand with your FDA Approval?
Briefly describe your target market, both industry and customer.
Do you currently have customers? Yes No
Do you currently have revenue? Yes No
Are you currently profitable? Yes No
Are you currently cash flow positive? Yes No
State your sales and profit estimations for the next three years.

Sales:
Current Year:
Forecast Year 1:
Forecast Year 2:
Forecast Year 3:
Profits
Current Year:
Forecast Year 1:
Forecast Year 2:
Forecast Year 3:

State your current number of employees:

Full Time:
Part Time:
Total:

Estimate your number of employee's for the next three years

Forecast Year 1:
Forecast Year 2:
Forecast Year 3:

Competition

List your main competitors?

Capital

Have you raised outside capital? Yes No
If Yes:
How much?
When?
From Who?

Outside Advisors

Accounting Representation:
Legal Representation:
Board Members:
Current Stakeholder:
Other Advisors:

Assistance Needed

Please provide a description of the business assistance you would like to receive from the Indiana Venture Center.

If you have been in contact with anyone at the Indiana Venture Center regarding your company prior to submitting this Business Profile, please indicate the individual(s).

Referral Source

How did you hear about the Indiana Venture Center?
Name:
Company:
Phone:
Other Source:

Disclaimer

To best serve you, it may be necessary for the Indiana Venture Center to disclose certain information to third-parties. These situations include, but are not limited to, consulting with industry experts for the purpose of concept validation; locating and raising funding through venture capitalists, financial institutions, and private investors; conducting market research to determine the novelty and viability of concepts; assisting in locating and working with partners; and pairing clients with mentors. The Indiana Venture Center assumes no liability for improper or unlawful use of such information by third-parties. By submission of this Business Profile, you are agreeing to the terms outlined herein.

All email addresses provided above will be added to the distribution list for the Indiana Venture Center eNews, a monthly electronic newsletter.

Your Signature (Please type in):