Company Name:
Company Website :
Sponsoring Organization:
LEVEL OF HEAVY LIFTING RECEIVED
Sourced:
Screened:
Mentored :
Incubated:
Angel:
Address 1:
Address 2:
City State/Province:
Country:
Phone #:
Fax #:
Contact Person / Title :
Contact Person's Email:
MANAGEMENT TEAM
1. First Name Last Name Title:
2. First Name Last Name Title:
3. First Name Last Name Title:
4. First Name Last Name Title:
5. First Name Last Name Title:
Total Number of Full Time Employees:
Total Number of Consultants/PT Employees:
Founded Date:

Legal Formation:	Select S Corp C Corp LLC Partnership Sole Proprietor

WEB PRESENCE
LinkedIn Address:
Facebook Address:
Plaxo Address :
Other:
Other:

PRODUCT / MARKET CLASSIFICATION
Is your Revenue Model based on a Product or Service :
Category:	Select Business Products and Services Marketing / Advertising Clean Technology Media and Entertainment Gaming Computers/Peripherals Hardware Medical Devices and Equipment Mobile Hardware Mobile Software/Apps Electronics / Instrumentation Networking and Equipment Financial Services Healthcare Services Software IT Services Industrial/Energy Telecommunications Internet / Web Services Web 2.0 Community/Applicationss Transportation Biotechnology Education

TARGET MARKET / USER
Business	Select Small Business Enterprise Sole Proprietor Non-Profit
Consumer	Select eCommerce Content
Government

CUSTOMERS/PARTNERSHIPS/RELATIONSHIPS

Company	Customer	Joint Development	Work 4 Hire	Distribution / Promotion

Company Revenue Model	Select Advertising Licensing Non-Profit Products Services Subscriptions Transaction Fees Other None

FINANCIAL HISTORY COMPANY FUNDING HISTORY

	Date Rcvd	Amount Rcvd	Financing Method (1)
Personal/Friends&Family Funds
Academic/Research Grants
Government Contract
Work-For-Hire Project(s)
Angel(s)
Venture Capital
OTHER
% Equity Owned by Founders

(1) Financing Method (Debt, Common Stock, Preferred Stock, Convertible Preferred, Work Compensation, Other)

REVENUE HISTORY
Pre-Revenue:	Select Yes No
Expected Date of Revenue Generation:
P&L History Year Revenue Expenses P/L
P&L Forecast Year Revenue Expenses P/L

ADD DOCUMENTS - add only those documents you wish to be viewable to registered Validation Partner and Funder members of the ESM. No documents you provide will be made available to other Sponsored Companies or 3rd Party Resources

	Download Date
Executive Summary:
Powerpoint Presentation:
Financial Plan:
Business Plan:
Patent Applications:
Patent Grants (Patent #):