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
Browse Files
Cancel
of
Does your company currently have a regulatory plan? (If YES, please upload)
*
Yes
No
Browse Files
Cancel
of
Does your company currently have an investor deck? (If YES, please upload)
*
Yes
No
Browse Files
Cancel
of
Does your company have financial statements? (If YES, please upload)
*
Yes
No
Browse Files
Cancel
of
Provide market definition, estimated market size
*
Credit from financial institutions (i.e. Banks, Caisses populaires, Credit Unions, Business Development Bank of Canada, Export Development Canada, Farm Credit Canada.)
*
Credit includes term business loans, non-residential mortgages, business lines of credit and credit cards.
Personal financing used towards your business
*
Personal loans, lines of credit or cards from financial institutions, and personal savings of business owners.
Financing from friends or relatives of business owner(s)
*
Financing from angel investors
*
An angel investor is an individual or group unrelated to the business that provides financial backing and often advice to a business. Do not include friends and relatives here.
Financing from venture capital providers
*
Other shareholders?
*
Government:
*
Includes loans, grants, subsidies, non-repayable contributions, or prizes
What are your financial requirements for the next 12-24 months?
*
In what area(s) can Emergence assist your company?
*
Submit
Should be Empty: