Application form

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Name *

First

Last

Email *

Company Name *

Level of product / service *

Brief Company Overview (Describe your business in one sentence) *

Total of Founder(s)

What problem does your company solve? *

What is your solution/product/service? *

Total Amount of Funding Sought *

Use of Funds (Breakdown how the funding will be allocated):Marketing: *

Product Development: *

Hiring: *

Other: *

Founder(s) Background (Brief Bio): *

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