Intake Form
Name of the company
*
Name of the Contact Person
*
First Name
Last Name
Title:
*
Email Address:
*
example@example.com
Phone Number:
*
Please enter a valid phone number.
Website:
Company Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Afghanistan
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Montserrat
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Nigeria
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Norway
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Paraguay
Peru
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Poland
Portugal
Puerto Rico
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Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
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Samoa
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Senegal
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Seychelles
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eSwatini
Sweden
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Vatican City
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Vietnam
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Isle of Man
US Virgin Islands
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Western Sahara
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Other
Country
Year Founded:
*
Legal Entity Type:
*
Please Select
C-Corp
LLC
S-Corp
Partnership
Sole Proprietorship
Non-profit
Number of Employees (FTE):
*
List key management team members and their relevant experience in agriculture, technology, or business:
*
Number of Employees (PTE):
*
Mission Statement:
*
Brief Description of your solution/product/service:
*
What specific problem does your solution address?
*
What is your target market?
*
Current stage of development:
*
Please Select
R&D
Prototype
Pilot
Commercialization
Key milestones to date:
Highlight any advisory board members or key investors:
*
Describe your core technology/innovation in detail:
*
What makes your technology unique or proprietary? (e.g., patents, trade secrets)
*
What scientific/technical validation has your solution undergone?
*
What are the key benefits of your solution for your customer?
*
How does your solution integrate with existing practices or infrastructure?
*
What is the estimated Total Addressable Market (TAM) for your solution?
*
What is the estimated Serviceable Obtainable Market (SOM) for your solution?
*
What is the estimated Compound Annual Growth Rate (CAGR) for this sector?
*
Who are your primary competitors?
*
What is your competitive advantage?
*
What are the key market trends driving demand for your solution?
*
How do you plan to acquire customers?
What is the total amount of funding you are seeking?
*
What is the minimum check size you are looking for?
*
What is your proposed use of funds? (e.g., R&D, marketing, team expansion, capital expenditure)
*
What is your current valuation (if applicable)?
*
What is your projected revenue for the next 1-3 years?
*
What are your key financial metrics (e.g., customer acquisition cost, lifetime value, gross margin)?
*
Have you raised previous funding?
*
Yes
No
If so, from whom and how much?
What is your exit strategy for investors?
*
Attach your latest financial statements (P&L, Balance Sheet, Cash Flow Statement)
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Attach your investor deck/pitch deck.
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Are there any relevant agricultural regulations or certifications that apply to your solution?
*
Yes
No
Are there any pending or past legal disputes?
*
Yes
No
Is there any other information you believe is important for us to consider?
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