Form Center • Temecula CA • CivicEngage

Step One

Company Name*
Applicant Name*
Title*
Address*
City*
State*
Zip Code*
Country
Phone Number*
Fax Number
Email Address*
Company Website
What date was your venture established?*
What date was your venture established?
What date was your venture established?
Is your venture incorporated?
1. Yes
1. No
Number of current full-time employees (including principles):*
Number of current part-time employees (including principles):*
Please estimate future full-time employees 1 year from now:*
Please estimate future part-time employment 1 year from now:*
How did you hear about us?
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In less than 150 words, provide an overview of your company/product/service. Include your intellectual property position ( patents, trade secrets, copyrights or trademarks.)*
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In less than 150 words, describe the customer problem or need that your product or service solves. To what markets are you going to sell? List the potential market sizes, if known.*
Describe your competition:*
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Please answer the following questions about the key members of your team.
Have any key members of your team been convicted or named in a criminal proceeding or pending criminal investigation?*
1. Yes
1. No
If yes, please explain.*
If no, please put N/A.
Are any of the key members of your team a party to a claim, action, suit, proceeding, arbitration, complaint, charge or investigation pending or currently threatened?*
1. Yes
1. No
If yes, please explain.*
If no, please put N/A.
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In less than 150 words, describe the status of your development (working on prototype, idea stage, product or service in pilot state, etc.), product/service development timeline, near term activites and key milestone*
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Current revenue per month:*
Have you secured any of the following to capitalize your business?*
1. Angel Investment
2. Corporate Partner Investment
3. Self-Funded
1. Venture Capital
2. Other Sources
If other, please specify:
Amount currently secured with Angel Investment:
Amount currently secured with Venture Capital:
Amount currently secured with Corporate Partner Investment?
Amount currently secured with Self-Funded?
Amount currently secured with other sources?
How does the company plan to finance its day-to-day business operations until it gets its next level of financing?*
What are your plans for future rounds of financing (describe any progress made to-date on this effort)?*
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Please include the following items:
Business Model/Plan:*
Please include information on potential markets and their size, growth potential for product line, financial pro formas, exit strategies/milestones and how those will be accomplished.

Please note that a draft business plan is acceptable.
List of All Officers:*
Please include a biography or resume for each officer.
Company Brochure or Marketing Material
(If available)
Authorization
My signature below certifies that all the information contained in this application is true and complete. I authorize the TVE2 to verify the information contained in this application by contacting any of the sources provided. I understand that this application, when submitted, becomes the property of the TVE2 and will be retained whether or not it is approved.
Applicant Name & Title*
Date*
Date
Date

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