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| Company Name:
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| First Name*:
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| Last Name*:
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| Address*:
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| Address 2:
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| City*:
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| Zip Code*: |
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| Phone*: |
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| Fax: |
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| Email*: |
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QUESTIONS: |
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1. |
In
which industry do you conduct the majority of your business? |
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Technology,
Internet or Telecom
Computer
- VARHardware/Software
Professional
Services, Accountants, Legal or Finance
Retail,Consumers,
Food Service, Sports or Entertainment
Manufacturing
- High Tech or Traditional
Oil,
Gas, Energy or Mining
Automotive,
Transportation or Aerospace
Education,
Health Care, Biotech or Social Assistance
Agriculture,
Farming or Environmental
Other
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2. |
What
is your primary product or service? |
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Please
type answer:
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3. |
How
long have you been in business? |
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0
- 6 months
6
months - 1 year
1
- 2 years
2
- 5 years
5
-10 years
over
10 years |
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4. |
How
is your business organized? |
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Sole
Proprietorship
Corporation
S
Corporation
Partnership
LLC
Other
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5. |
What
stage of development best describes your company? |
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Start
Up
Research
and Development Only
Prototype
Completed
Pre-Beta
Trials or Surveys
Beta
Deployment/Testing
Pre-Production
In
Production, but not yet Generating Sales
Generating
Sales, but not Profitable
Generating
Sales and Profitable |
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6. |
What
is your current geographic market? |
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Local
Statewide
Regional
National
International |
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7. |
What
is the size of your market? (in annual dollar sales) |
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8. |
What
is the estimated growth for your product/service? (in annual dollar sales) |
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9. |
What
are your expected/forecasted sales for: |
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Next Year:
Year after next:
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10. |
What are gross margins for your company? |
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11. |
What is the estimated target market/industry gross margins for your product/service? |
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12. |
Choose the option that best describes the pricing power for your product/service: |
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High
Medium
Low
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13. |
Are you cash flow, operating cash flow and/or operating income positive?
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At least one of the above
None of the above
If none of the above, when do you estimate or forecast when your company will be positive for cash flow, operating cash flow and operating income?
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14. |
What is the current book value (net worth) of your business? |
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15. |
What is the current working capital for your business? |
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16. |
What is your debt position? |
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Current:
Long-term:
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17. |
How did you discover PCMC or hear about our services?
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18. |
How have you been funded in the past? |
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Debt
Equity
Other
Please Explain:
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19. |
What type of barriers to entry exist in your marketplace? |
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20. |
Explain your product/service differentiation (price, quality or unique service/product): |
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21. |
What
are your last 12 months revenues? |
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22. |
How
much have your sales grown over the last year? |
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No
Sales Yet
Negative
SalesGrowth
0
- 10%
10
- 20%
20
- 50%
50
- 100%
More
than 100% |
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23. |
What
is your most recent 12 month profit/loss? |
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24. |
Do
you hold any patents or other significant intellectual
property that gives your company distinct competitive advantage? |
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yes
no
If "yes" explain:
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25. |
Does
your business require the use of another company's
patent(s), trademark(s), copyright(s) or rights to generate
a
significant portion of your revenue? |
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yes
no
If "yes" explain:
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26. |
How
much financing have you received in the last year? |
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27. |
What
amount of capital are you seeking from a Founders Round? |
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28. |
How
will you use the funds raised from a Founders Round? |
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Please
type answer:
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29. |
Please
describe in detail what the sources of your revenue are
or will be. Please be as specific as possible. |
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Please
type answer:
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30. |
Are
your clients or consumers potential investors in
your company? |
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yes
no |
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31. |
Are
your close business contacts or friends potential investors
in your company? |
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yes
no |
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32. |
Are
you under contract with any source that has rights to stock
in your company? |
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yes
no |
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33. |
Is
your company involved in any type of lawsuit? |
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yes
no |
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34. |
Rate
the complexity to the average investor of understanding
your business model and objectives: |
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Simple,
any adult would understand it.
Moderate,
need general knowledge to understand it.
Hard, need specific knowledge of the industry to understand
it.
Impossible, only a few experts would understand the complexity. |
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35. |
How
long does it take to explain to a potential investor why
they should invest in your company? |
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Less
than 5 minutes
5
- 10 minutes
10
- 15 minutes
15
- 30 minutes
More
than 30 minutes |
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36. |
In
what state (or province) is your primary office located?
(i.e. California, etc.) |
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Please
type answer:
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37. |
Do
you have a website? |
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yes
no
If "yes":
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38. |
Any
additional comments: |
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39. |
Business
Plan Review. If you have a business plan you would like to have
reviewed, please upload up to 5 relevant documents here. |
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Note: Print this out before you click submit, so you have copy on hand during the consultation. |
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