Virgin Startups Referral Form

Your details:

Lead Source

Lead Source Detail

Lead Status

Lead Type

Lead Currency

Your full name: *

First Name Last Name

Your email address: *

Please use the same email that's attached to your Crowdcube account.

Partner code: (if applicable)

Referring company details:

The company's main contact: *

First Name Last Name

Their email: *

example@example.com

Company name: *

Companies House Number: *

Company website: *

Founder/CEO LinkedIn:

Where is their company based? *

Short description of their business:

Up to 120 words.

By submitting your application you (i) agree to receive communications from Crowdcube and Virgin Startup about this programme; (ii) agree and acknowledge that all data and confidential information submitted may be shared by Crowdcube with Virgin StartUp and other third parties, including potential investors, for the purposes of the programme; and (iii) you acknowledge that you understand that the Collective Impact programme is a separate service to any services Crowdcube may provide you and that you must pass Crowdcube Due Diligence in order to list your pitch on Crowdcube.

Please read Crowdcube and Virgin StartUp’s privacy policies for a more detailed explanation of how Crowdcube and Virgin StartUp will collect, use and store information relating to you.