ipapplication

CEO Netweavers Inflection Point Application Form
I. Personal Data:

Tell us about yourself
Full Name *

First Name Last Name
Business Name:
Title
Mobile No. : *

Area Code Phone Number
E-mail : *
Where the confirmation will be send to
Website
Linked In
Industry Type:
Type Of Org

Profit Non-Profit
Year Business Started
Primary Focus

Business to Business Business to Consumer
Company Type

Product Company Services Company
Financial Stage

Pre Revenue Has Revenue
Number of Full Time Employees:
Number of Part Time Employees:
Ownership

C-Corp S-Corp Partnership Unstructured
Product/Service Status

Trial/Testing Pre Production Commercially Available
Number of Clients:
The Company Is

Profitable Not Profitable
Company Background and Goals
Key Activities, Resources, and Value Proposition?
Do You Have A Business Model? If So, Please Provide A Brief Description
What Are The Company's Products/Services And it's Market Opportunity?
Who Are Company Customers/Clients and Channel Partners?
Who Are They Key Competitors, Their Advantages or Disadvantages?
Do you Have Any Strategic Alliances Which Provide Your Company With A Competitive Advantage?
Describe Your Sales, Marketing, And Distribution Methods?
Four or More Challenges That You Want Help From the Inflection Point Panel Members? (Be Specific)
Why Do You Want To Participate In The IP Program And What Is Your Expected Outcome?
Is There Any Other Information You Would Like Us To Have?
Office Address : *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Optional Informations : Information regarding gender, ethnic origin and race are optional. The information is requested for report generation only and in no way affects your selection.
Gender:

Male Female
Are you a US citizen?

Yes No
Ethnic Origin:

Hispanic Non-Hispanic Not Indicated
Race? (Choose one or more):

White Black or African American Asian American Indian or Alaskan Native Hawaiian or Other Pacific Islander Non-Resident Alien
Please check veteran status (Check all that apply)

Veteran Child of a Veteran Grandchild of a Veteran Spouse of a Veteran None of the Above
VIII. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature: *
Should be Empty:

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CEO Netweavers Inflection Point Application Form

I. Personal Data:

VIII. Applicant's E-Signature