Rocket Ventures // Events

Client Intake Form

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Company Contact
Your Title:
Your Full Name:
Your Position With The Company:
Phone:
Cell Phone:
Email Address:	(E-mail)
Company Information
Company Name:
Address:
Address 2:
City:
State:
Zip Code:
FAX_Number:
Website Address:
About My Company
Which Technology Area Do You Best Fit?:
What Best Describes The (Stage of Development) of Your Product/Service?:
Do You Possess Intellectual Property ?:	Yes No
What does your Product/Service offer the market place?:
What problem does your Product/Service solve in the market place?:
Additional Comments:
Company Dollar Status
Number of Full Time Employees:	Please Enter Numbers Only
Revenue Total For The Last 12 Months:
Capital Investment to Date:	You Can Enter Decimal Here
Have You Received Other Investment Funding:*	Yes No
How Did You Hear About Rocket Ventures/RGP :*
Previous Contact:*	Yes No
Do You Have A Business Plan?:*	Yes No
Upload Your Business Plan: (Optional)	To Upload - Your Business Plan file must be a PDF, 5 megs or less.

Company Contact

Company Information

About My Company

Company Dollar Status

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