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Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
County
*
Please Select
Barbour
Berkeley
Boone
Braxton
Brooke
Cabell
Calhoun
Clay
Doddridge
Fayette
Gilmer
Grant
Greenbrier
Hampshire
Hancock
Hardy
Harrison
Jackson
Jefferson
Kanawha
Lewis
Lincoln
Logan
Marion
Marshall
Mason
McDowell
Mercer
Mineral
Mingo
Monongalia
Monroe
Morgan
Nicholas
Ohio
Pendleton
Pleasants
Pocahontas
Preston
Putnam
Raleigh
Randolph
Ritchie
Roane
Summers
Taylor
Tucker
Tyler
Upshur
Wayne
Webster
Wetzel
Wirt
Wood
Wyoming
Amount of Funding:
*
Under $50k
$50k to $250k
$250k to $500k
Over $500k
Type of Funding:
*
Venture Capital
Loan
Both
Sector:
*
Tech
Medical
Retail
Food/Beverage
Consumer Services (hairdresser/daycare/etc)
Business Services (Accounting/Financial services/etc)
Manufacturing
Other – provide description
Brief Description of project
*
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