1. Register of Interest
Company Name
*
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Company Website
*
Please provide the full formatted address i.e. http://www.mysite.com
Date of Registration
-
Month
-
Day
Year
Date
Company Logo
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CEO
*
First Name
Last Name
LinkedIn Profile Link (if any)
Contact Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
*
What stage is your company in?
*
Pre Seed
Seed
Series A
Series B
Series C +
What tech family/cluster does your company belong to?
*
AdTech
AgriTech
BioTech
CleanTech
DeepTech
EdTech
FinTech
FoodTech
InsurTech
IOT
LegalTech
MedTech
PropTech
RealTech
RegTech
RetailTech
Robotics
Other
Which tech family/cluster do you belong to (if Other)?
Are you revenue generating?
*
Yes
No
Type of Activity
*
B2B
B2C
B2G
B2B2C
B2B2X
Other
How did you get in contact with us?
*
Internet Search
Database
Basinghall Partner
Basinghall Innovation Circle
Who is your Basinghall Partner contact?
*
Andrew Irvine
Ginette Oebel
Yannick Wilden
Other
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2. Company Business Model
Please describe your business model
*
Value Proposition and Offering
0/200
Product Type
*
Services
Hardware
Enterprise Software
Software as a Service
Other
Product Type (if Other)
Product Stage
*
1. Idea
2. Minimum Viable Product
3. Proof of Concept
4. Use Cases
5. Active Customers / Recurring Revenue
6. Growth
Please describe which main customer's pain point(s) your value proposition is solving
*
0/200
Unique Selling Point #1
*
0/200
Unique Selling Point #2
*
0/200
Main Technology
*
Analytics
API
Application (Web based)
Application (Desktop/Mobile)
Artificial Intelligence (AI)
Blockchain
Cloud Computing
Augmented Reality (AR)
Virtual Reality (VR)
Sensors
Robotics
IOT
Cyber Security
3D Printing
Energy storage
Energy generation
Fuel Cell
Other
Main Technology (If Other)
TOP 3 Target Industries
*
Generic Solution (industry agnostic)
Administrative and Support
Advertising
Aerospace
Agriculture
Automotive
Chemical & Pharma
Construction
Consulting and development
Educational Services
Electronics
Energy
Finance & Insurance
FMCG
Food & Beverage
Government and public service
Health Care
Information and Telecommunication
IT
Logistics
Manufacturing
Marine
Media
Mining
Mobility
Oil and Gas
Scientific, Research and Technical Services
Real Estate
Retail
Social care
Software
Textile
Transportation
Travel, Tourism and Recreation
Utilities
Warehousing
Other
Target Industries (If Other)
Specify Activity within Industry
*
Impact on Industry
*
Disruption
New Market
Cost Efficiencies
Additional Sales
Solution along the value chain - Impact on the value chain
*
Standalone Solution
Inbound Logistics
Operations
Outbound Logistics
Marketing and Sales
Service
Procurement
Technological Development
Human Resource Management
Infrastructure
Other
Solution along the value chain (If Other)
Please describe one use case
*
0/200
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4. Company Core Team
Number of Employees
*
Have any of the founder(s) left?
*
Yes
No
How long has the founding team been working together (in years)?
*
Have any of the founders established a company before?
*
Yes
No
If Yes, what is the company's current status?
Exited
Operating
Dormant/Dissolved
Not Applicable
What is the engagement of the core team in the company?
*
Answer in average team time commitment % engagement
Does anyone in the core team participate in any unrelated business activity?
*
Yes
No
What is the primary strength of the team?
*
What is the primary weakness of the team?
*
Which profile would best expand the core management team?
*
Answer in type of resource profile i.e. technical, sales, finance, etc...
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5. Company Technology
Does the company develop its main technology and/or its own technology platform?
*
Yes, main technology
Yes, technology platform
Yes, both
No
Where is development done?
*
In-house
Does the company own intellectual property (IP) patents related to its technology?
*
Yes
No
Does the company make use of intellectual property (IP) licensed by external companies?
*
Yes
No
Who is the licensed provider?
Is the license exclusive?
Yes
No
What is the duration of the license (in years)?
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6. Customers
Number of active customers
*
Please only include paying customers
Top Customer #1
*
Top Customer #2
*
Top Customer #3
*
Region(s)
*
Europe
North America
South America
Africa
Middle East
Asia/Pacific
How long do you need to implement your solution (months)
*
APIs necessary
*
Acquisition cycle per customers (months)
*
Customer Lifetime (months)
*
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7. Market(s)
Estimated Total Market Size (EUR)
*
(Use the format 0.00 ) Answer 0 if unknown
Top Competitor #1
*
Top Competitor #2
*
Top Competitor #3
*
Top Challenge #1
*
Top Challenge #2
*
Top Challenge #3
*
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8. Company Financials
End of current fiscal year
*
-
Month
-
Day
Year
Date
Revenues - Past fiscal year (EUR)
*
(Use the format 0.00 )
Projected Revenues - Current fiscal year (EUR)
*
(Use the format 0.00 )
Projected Revenues - Next fiscal year (EUR)
*
(Use the format 0.00 )
Current annual rate of expenditure (EUR)
*
(Use the format 0.00 )
Burn rate last month (EUR)
*
Monthly Recurring Revenue (EUR)
*
(Use the format 0.00 )
Gross Margin (%)
*
Estimated Revenues in 5 years (EUR)
*
(Use the format 0.00 )
Estimated EBITDA in 5 years (EUR)
*
(Use the format 0.00 )
Estimated market-share in 5 years (%)
*
Answer 0 if unknown
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9. Funding
Number of past funding rounds (excluding current)
*
Date of Last Funding Round
-
Month
-
Day
Year
Date
Current Investors
*
Founders
Accelerators
Angels
Friends & Family
Private Investor
Venture Capital
Number of Shareholders
*
Percentage of shares held by founders (%)
*
Last Valuation (EUR)
*
(Use the format 0.00 )
Current fund-raise volume (EUR)
*
(Use the format 0.00 )
Committed volume (EUR)
*
(Use the format 0.00 )
Pre-money valuation (EUR)
*
(Use the format 0.00 )
Expected number of future funding rounds
*
Excluding the current one
Expected total future volume (EUR)
*
(Use the format 0.00 )
Main use of funds #1
*
Product Development
Organisation
Capital Expense (CAPEX)
Working Capital
Personnel
Sales
Marketing
Shareholder Buyout
Refinancing
Main use of funds #2
*
Product Development
Organisation
Capital Expense (CAPEX)
Working Capital
Personnel
Sales
Marketing
Shareholder Buyout
Refinancing
Expected Closing Date
*
/
Day
/
Month
Year
Date
Please add your most recent Pitch deck and your most recent Sales deck
Browse Files
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Information Consent
Would you like to become a member of the Basinghall Innovation Circle, our innovation platform which actively connects our industry partners and startups? - The Participation is free of any charge, you will be a visible member which allows us to connect you with interested partners and/ or potential customers wherever it is applicable
*
Yes
No
I consent to Basinghall Partners using the information collected through this form
*
Yes
No
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