Emergence Client Intake
Company Name
*
Date of incorporation
*
-
Month
-
Day
Year
Date
Company Contact
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Website
*
Please list current management team including Scientific Advisors / Board Members
*
Provide a brief company description
*
How many full time employees?
*
How many part time employees?
*
How many Founders are Indigenous Peoples (Metis, Inuit, First Nations)?
*
How many Founders are female?
*
Does your company currently have a business plan? (If YES, please upload)
*
Yes
No
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Does your company currently have a regulatory plan? (If YES, please upload)
*
Yes
No
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Does your company currently have an investor deck? (If YES, please upload)
*
Yes
No
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Does your company have financial statements? (If YES, please upload)
*
Yes
No
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Does your company have a marketing plan? (If YES, please upload)
*
Yes
No
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Provide market definition, estimated market size
*
What is the current financial position of your company?
*
Cash on hand
What is your company's burn rate?
*
What are your financial requirements for the next 6-24 months?
*
In what area(s) can Emergence assist your company?
*
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