Company Intake Information Form
FINANCING TECHNOLOGY COMMERCIALIZATION - 2018
Professor David Brophy
Ross School of Business, University of Michigan
Please Note:
All program particpants will sign Non-Disclosure Agreements for your company.
1. Company Name
Please enter the name of your company:
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2. Management Team Information
a. Founders, other C- level Executives and Employees by function. (Please distinguish between full-time and part-time.
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b. What is the length of time the management team has worked together? And in what capacity?
c. List of Board of Directors and Advisors
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3. Company Summary (“One Line Pitch”)
Please enter your short pitch here.
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4. Product and Core Technology
a. Description of Product and Core Technology
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b. What is the status of your Intellectual Property?
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5. Target Market:
a. Description and estimated size of total market
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b. Description and estimated size of your addressable market
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6. Customers
a. Do you have current customers or letter of intent? Please identify customers.
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b. Definition of your target customer
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c. What is the current customer pain and need to cure it?
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d. What is your Current estimated (2017) annual revenue?
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Pre-revenue
< $500k
$500k - $1million
> $1 million (please enter amount below)
Other
7. Competitors
a. Who are your current competitors?
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b. What products and services do they have in the current market?
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c. What is your competitive advantage against existing and entering competition?
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d. Why do customers buy from you instead of from your competitors?
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8. Current Status
a. How much funding are you currently seeking?
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b. Have you received any funding or grants for your business?
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What types of funding have you received? (If applicable)
Friends and Family
Grant or Stipends
Angel
Venture Capital Series A
Venture Capital Series B/C/Other
c. Have you received any award or media attention for your idea? Please provide description or content.
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9. Availability
Are you able to attend class on Wednesday from 7-10PM?
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Yes
No
If No, will you participate by Blue Jeans, Skype or other online facility?
10. Primary Mode of Internal Communication
What are the primary modes of communication used by your internal executive team?
Email
Slack
SMS
Voice Phone
Other
11. Tools you use for storing and working with Structured and Unstructured Data
Please list the tools you use for storing and working with structured and unstructured data. (i.e., Trello, Evernote, Google Docs, Airtable, Task Management Software, Bug Tracking, CRM, other).
12. Additional Documents
a. Executive Summary (required)
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b. Current Business Plan
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