TechConnect WV TechWrx Application

TechConnectWV TechWrx Application
TechConnect WV TechWrx Application

Tech Connect WV (TCWV) coordinates and collaborates TechWrx with its centers of excellence to provide an integrated continuum of direct technical assistance to inventors, entrepreneurs, manufacturers, and businesses seeking technology-driven solutions and opportunities. To be eligible for TechWrx support your business must first be located in one or more of the following West Virginia counties: Barbour, Boone, Braxton, Cabell, Calhoun, Clay, Doddridge, Fayette, Gilmer, Grant, Greenbrier, Harrison, Jackson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, Mason, McDowell, Mercer, Mingo, Monongalia, Nicholas, Ohio, Pocahontas, Preston, Putnam, Raleigh, Roane, Taylor, Tyler, Tucker, Upshur, Wayne, Webster, Wetzel, Wirt and Wyoming.

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Complete the Application below. TechConnect West Virginia (TCWV) will contact you soon.
Date

MonthDayYear
Name*

First NameLast Name
Company Name*
D.B.A. (Doing Business As)
EIN
WV Business Registration Account #
Business Structure*
E-mail*
Website
Business Phone*

Area CodePhone Number
Mobile Phone

Area CodePhone Number
FAX

Area CodePhone Number
Physical Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Shipping/Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Same as Physical Business
Disclosure (what is the product, service, business or other idea):*
Upload Supporting Information or other File(s): (Up to 20MB per file). If you are unable to upload your file type please note in the "File Upload Comment Box" below. We will make other arrangements to receive your file.

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File Upload Comments
Type of Company/Entity*
Years in Business
Jobs Created*
Jobs Retained*
Anticipated Follow-on Financing (in addition to TechWrx)*
Follow-on Financing Comments
New Business Formed?*

YesNo
Number of Business(es) or Business Divisions Formed*
Name of Product, Service or Idea*
Describe or Link Current or Anticipated Media Coverage
Region (Projects available for TechWrx assistance should be located in one or more of the grant service counties)*

BarbourBooneBraxonCabellCalhounClayDoddridgeFayetteGilmerGrantGreenbrierHarrisonJacksonKanawahaLewisLincolnLoganMarionMarshallMasonMcDowellMercerMingoMonongaliaNicholasOhioPocahontasPrestonPutnamRaleighRoaneTaylorTuckerTylerUpshurWayneWebsterWetzelWirtWyoming
How did you learn about TechWrx?

Google SearchBusiness EventTCWV WebsiteOther
Please describe the benefits of your invention, idea or product in 50 words or less.
Stage of Development:

Already being ProducedProduction Model ReadyMultiple PrototypeSingle PrototypeProof of conceptCombination of proven methodsIdea Only
Time to Market

Existing SalesLess than 6 months to salesLess than 1 year to salesLess than 2 years to salesMore than 2 years to sales
Intellectual Property Status

Patent IssuedPatent PendingProvisional PatentCopyrightTrade Secret
Estimated Sales Forecast

>$200M in year 5>$50M in year 5>$10M in year 5>$5M in year 5>$1 in year 5>$1M in year 5
Size of Market

Huge (>$10B in Annual Sales)Very Large (>$1B in Annual Sales)Large (>$250M in Annual Sales)Medium (>$50M in Annual Sales)Small (< $50M in Annual Sales)Very Small (< $5M in Annual Sales)
Value Improvement over Current Products:

>10X improvement>5X Improvement>2X Improvement50% - 2X improvement< 50% improvementOther
Market Validation:

Already selling productPending ordersDocumented customer intentDocumented market studyGeneral customer interestLikely Interest
List existing competitors and/or competing products:
Are you seeking investment?

YesNoI don't know
If so, how much?
What other assistance do you need?
By checking this box, it is understood that any information shared between the potential client and TechWrx will remain confidential.*

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TechConnectWV TechWrx Application