Remix Capital Raising Form

1
Full Name* This field is required.
First Name
Last Name
2
Email Address* This field is required.
example@example.com
3
Phone Number* This field is required.
Area Code
Phone Number
4
Company Name* This field is required.
5
Company Website
6
Business Description* This field is required.
7
What is your current funding stage?* This field is required.
Pre-Seed
Seed
Series A
Series B
Growth
Other
8
Amount of Capital Required ($)* This field is required.
9
Use of Funds* This field is required.
10
What was the last twelve months revenue?* This field is required.
11
Projected Revenue for Next Year ($)* This field is required.
12
What was the last twelve months expenses?* This field is required.
13
Projected Expenses for Next Year ($)* This field is required.
14
Key Financial Metrics (e.g., EBITDA, Profit Margin)
15
Appointment
Should be Empty: