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PROJECT FUNDING QUALIFICATION FORM
10
Questions
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1
PROJECT TYPE / INDUSTRY
WHAT BEST DRSCRIBES YOUR PROJECT ?
RENEWABLE ENERGY
INFRASTRUCTURE
AGRICULTURE
REAL ESTATE
MINING / NATURAL RESOURCES
OTHER
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2
PROJECT STAGE
WHAT STAGE IS YOUR PROJECT CURRENTLY IN?
IDEA/CONCEPT ONLY
EARLY PLANNING
FEASIBILITY STUDY COMPLETED
FULLY DEVELOPED/OPERATIONAL
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3
PROJECT DESCRIPTION
BRIEFLY DESCRIBE YOUR PROJECT
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4
LEGAL AUTHORITY
WHAT IS YOUR ROLE IN THIS PROJECT?
OWNER/FOUNDER
DIRECTOR/ EXECUTIVE
AUTHORIZED REPRESENTATIVE
CONSULTANT
OTHER
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5
FUNDING AMOUNT
How much funding are you seeking?
under $10M
$ 10M - $50M
$50M - $250M
$ 250M +
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6
TIMELINE EXPECTATION
HOW SOON ARE YOU LOOKING TO SECURE FUNDING?
10-12 WEEKS
3-6 MONTHS
JUST EXPLORING OPTIONS
NEED IMMEDIATE FUNDING
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7
CONTACT INFORMATION
First Name
Last Name
Please enter your phone
Company Name
Country
City
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8
AUTHORISED CORPORATE EMAIL ADDRESS
PLEASE ENTER YOUR OFFICIAL, INSTUTUTIONAL OR CORPORATE DOMAIN EMAIL. FREE PUBLIC DOMAIN ( GMAIL, YAHOO )
AUTHORISED EMAIL ADDRESS
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9
REGISTERED CORPORATE HEADQUATERS ADDRESS
PROVIDE THE FULL LEGAL PHYSICAL ADDRESS OF THE APPLICANT ENTITY
SUITE/FLOOR
CITY
STATE/PROVINCE
COUNTRY
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10
DOCUMENTATION
DO YOU HAVE SUPPORTING DOCUMENTS AVAILABLE?
YES, PITCH DECK
YES, FEASIBILTY STUDY
YES, FINANCIAL SUMMARY
NO DOCUMENTS YET
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