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Investor Application
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Investor Application
Step 1 of 3
33%
Contact Information
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Phone
*
Email
*
Investor Type
*
I am a Start up
I'm an Accredited Investor
I'm a Service Provider
Company name
*
Title
*
Associate/Staff
Manager/Supervisor
VP/SVP/Dept Head
C Level Executive (CEO, CFO, etc...)
Founder/Owner/Principal
Other
Year Founded
*
Industry
*
Accounting
Advertising
Agriculture
Apparel
Arts
Automotive
Banking
Bio-Technology
Construction
Consulting
Design
Education
Energy
Engineering
Entertainment
Finance
Food Service/Restaurant
Government
Graphic Design
Hardware
Healthcare
Hospitality
Human Resources
Insurance
Internet
Investing
Legal
Manufacturing
Marketing/PR
Media
Nanotechnology
Non Profit
Pharmaceuticals
Printing
Real Estate
Recreation
Retail/Clothing
Self Storage
Software
Sports/Recreation
Staffing/Recruiting
Technology/Web
Telecommunications
Textiles
Transportation
Venture Capital
Wholesale
Invention
Other
Legal Status
*
Not Incorporated
Limited Liability Company
Limited Liability Partnership
Limited Partnership
Nonprofit Corporation
Corporation
Sole Proprietorship
Incorporated Outside United States
Business Stage
*
Creation/Idea
Growth (not profitable)
Growth (profitable)
Mature
Decline
Country
*
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
City
*
Postal Code
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Number of Employees
*
1-10 people
10-50 people
50-100 people
100-250 people
250-500 people
500-1000 people
1,000-10,000 people
10,000 or more
Please enter a brief description of your company
*
Investor Type
*
Angel
Investment Banker
Private Equity
Venture Capital
Bank
Capital Broker
Real Estate
Minimum Investment
*
Maximum Investment
*
What type of funding do you provide (select all that apply)
*
Equity Funding (VC, Angel, PE)
Loan/Lease Funding
Commercial Mortgage/Lease
Equipment Financing
Alternative/Creative Finance
Business Acquisition/Franchise Funding
Debt Consolidation
Operational/Growth Funding
Receivables/Invoice Factoring
Merchant Cash Advance
Secured Loan
Unsecured Loan
What Industries do you Invest in?
*
Accounting
Advertising
Agriculture
Apparel
Arts
Automotive
Banking
Bio-Technology
Construction
Consulting
Design
Education
Energy
Engineering
Entertainment
Finance
Food Service/Restaurant
Government
Graphic Design
Hardware
Healthcare
Hospitality
Human Resources
Insurance
Internet
Investing
Legal
Manufacturing
Marketing/PR
Media
Nanotechnology
Non Profit
Pharmaceuticals
Printing
Real Estate
Recreation
Retail/Clothing
Self Storage
Software
Sports/Recreation
Staffing/Recruiting
Technology/Web
Telecommunications
Textiles
Transportation
Venture Capital
Wholesale
Invention
Other
What Countries do you Invest in?
*
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Briefly describe the type(s) of companies that you like to fund:
*
What services do you offer? (select all that apply)
*
Business Planning
Capital Broker
Logo Design
Legal
Marketing/Advertising
Office Supplies/Furniture
Office Equipment
Phone Systems
Printing/Signage
Project Management
Sales Consulting
Shipping/Logistics
Staffing
Accounting Services
Business Consulting
Real Estate
IT System Development
Website Development
Outsourcing
Incorporation Services
Business Insurance
E-commerce Solutions
Credit Card Processing
VOIP
Merchant Cash Advance
Search Engine Optimization
Pay-per-click
Funding -> Business Acquisition / Franchise Funding
Funding -> Equipment Leasing
Funding -> Commercial Mortgage
Funding -> Operation Capital
Funding -> Debt Consolidation
Website Hosting
Telemarketing
Payroll
Point Of Sale
Business Credit Building
Professional Appointment Setting
Higher Education
Commercial Mortgage
Commercial Mortgage
Equipment Leasing
Patent Idea or Invention
Please enter a brief description of your company:
*
Choose Services options
*
Funding (can help you find funding for your growing business.)
Business Plan Consulting Services (Building a professional business plan is absolutely key to funding.)
Web Hosting (Find companies with reliable and cost-effective plans for hosting your website.)
Website Services (Connect with talented designers to create your first website or redesign your web presence.)
Online Marketing (Search Engine Optimization and Search Engine Marketing - Work with experts to get your website to show up higher in Google and other search engines (SEO) and market through Google Adwords and other pay-per-click campaigns (SEM).)
Phone Systems/Voice Over IP Services (VOIP) -Save up to 80% on your monthly phone bills by switching to a VOIP phone service.
Credit Card Processing - Find the lowest rates or start accepting credit cards to maximize your revenue.
Merchant Cash Advance - Secure money within 72 hours if you currently process credit cards.
Patent for Idea or Invention - Expert patent application services for new products, original processes and great ideas.
Company Name
*
Year founded
*
Industry
*
Accounting
Advertising
Agriculture
Apparel
Arts
Automotive
Banking
Bio-Technology
Construction
Consulting
Design
Education
Energy
Engineering
Entertainment
Finance
Food Service/Restaurant
Government
Graphic Design
Hardware
Healthcare
Hospitality
Human Resources
Insurance
Internet
Investing
Legal
Manufacturing
Marketing/PR
Media
Nanotechnology
Non Profit
Pharmaceuticals
Printing
Real Estate
Recreation
Retail/Clothing
Self Storage
Software
Sports/Recreation
Staffing/Recruiting
Technology/Web
Telecommunications
Textiles
Transportation
Venture Capital
Wholesale
Invention
Other
Average Monthly Sales
*
Less Than $2,500
$2,500 to $5,000
$5,000 to $10,000
$10,000 to $20,000
$20,000 to $50,000
$50,000 to $100,000
Above $100,000
Number of Employees
*
1-10 people
10-50 people
50-100 people
100-250 people
250-500 people
500-1000 people
1,000-10,000 people
10,000 or more
Purpose of Funding:
*
Business Acquisition / Franchise Funding
Commercial Mortgage
Equipment Financing
Operating/Growth Capital (Payroll, Sales & Marketing, etc)
Debt Consolidation
I'm interested in the following funding types:
*
Equity Funding (Venture Capital, Angel, Private Equity, etc)
Alternative or Loan Funding
IRA/401K Financing (used to start business or qualify for a loan)
