Register of Interest
1.1 Company Name
*
1.2 Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
1.3 Company Website
*
Please provide the full formatted address i.e. http://www.mysite.com
1.4 Year of Registration
*
-
Month
-
Day
Year
Date
1.5 Company Logo
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1.6 CEO
*
First Name
Last Name
LinkedIn Profile Link (if any)
1.7 CFO
*
First Name
Last Name
LinkedIn Profile Link (if any)
1.8 CTO
First Name
Last Name
LinkedIn Profile Link (if any)
1.9 Head of Sales & Marketing (if any)
1.10 Contact Name
*
First Name
Last Name
1.11 Contact Email
*
example@example.com
1.12 Contact Phone Number
*
1.13 How did you get in contact with us?
*
Internet Search
Database
Basinghall Partner
Basinghall Innovation Circle
1.14 Who is your Basinghall Partner contact?
*
Andrew Irvine
Ginette Oebel
Yannick Wilden
Ilya Velder
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Company Business Model
2.1 Type of activity
*
B2B
B2C
B2B2C
B2B2X
B2G
2.2 Please describe your value proposition and offering to your customer
*
2.3 Please describe which main customer's pain point(s) your value proposition is solving
*
2.4 Please describe the TOP benefits that you bring to your customer
*
2.5 Product Type
*
Services
Hardware
Software
Combined
2.6 Unique Selling Point #1
*
2.7 Unique Selling Point #2
*
2.8 Unique Selling Point #3
*
2.9 Main Technology
*
Artificial Intelligence (AI)
Blockchain
Virtual Reality (VR)
Sensors
Augmented Reality (AR)
Robotics
Big Data
IOT
Data and Privacy Protection
Cyber Security
3D Printing
Machine Learning
Cloud Computing
2.10 TOP 3 Target Industries
*
Accommodation & Food Service (HoReCa)
Administrative and Support
Aerospace
Agriculture
Agriculture, Forestry, Fishing & Hunting
Arts and Entertainment
Automotive
Central Administrative Office Activity
Chemical & Pharma
Cities and urban development
Construction
Consulting and development
Consumer Products
Educational Services
E-Sports
Finance & Insurance
FMCG
Food & Beverage
Foundation
Government and public service
Hardware
Health Care and Social Assistance
ICT
IT
Logistics
Management of Companies
Marine
Media
Mining
Mobility
Oil, Gas, Energy
Professional, Scientific and Technical Services
Property and facility management
Public Service
Real Estate
Research & Information
Retail
Retail Trade
Service and platfrom
Social care
Software
Telecom
Transportation
Travel, tourism, recreation
Utilities
Warehousing
Waste Management
Other Services (except Public Administration)
2.11 Impact on Industry
*
Disruption
New Market
Cost Efficiencies
Additional Sales
2.12 Product Stage
*
1. Idea
2. Pilot
3. Minimum Viable Product
4. Use Cases
5. Active Customers
2.13 Solution along the value chain - Impact on the value chain
*
Purchase
Logistics
Inventory
Production
Maintenance
Marketing
Sales
Human Resources
E -Learning
Organisation
Finance
New Business Models
Supply
Research & Development
Quality & Assurance
Administration
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Company Core Team
3.1 Number of Employees
*
3.2 Have any of the founder(s) left?
*
Yes
No
3.3 How long has the founding team been working together (in years)?
*
3.4 Have any of the founders established a company before?
*
Yes
No
3.5 If Yes, what is the company's current status?
Exited
Operating
Dormant/Dissolved
Not Applicable
3.6 What is the engagement of the core team in the company?
Answer in average team time commitment % engagement
3.7 Does anyone in the core team participate in any unrelated business activity?
*
Yes
No
3.8 What is the time consumption on such activity?
Answer in average % commitment
3.9 What is the primary strength of the team?
*
3.10 What is the primary weakness of the team?
*
3.11 Which profile would best expand the core management team?
*
Answer in type of resource profile i.e. technical, sales, finance, etc...
3.12 How can Basinghall Partners best support the company?
*
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Company Technology
4.1 Does the company develop its main technology and/or its own technology platform?
*
Yes, main technology
Yes, technology platform
Yes, both
No
4.2 Where is development done?
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In-house
4.3 Does the company own intellectual property (IP) patents related to its technology?
*
Yes
No
4.4 Does the company make use of intellectual property (IP) licensed by external companies?
*
Yes
No
4.5 Who is the licensed provider?
4.6 Is the license exclusive?
Yes
No
4.7 What is the duration of the license (in years)?
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Customers
5.1 Number of Active Customers
*
0
1-5
6-10
11-50
51-100
100+
5.2 Top Customer #1
*
5.3 Top Customer #2
*
5.4 Top Customer #3
*
5.5 Region(s)
*
Europe
North America
South America
Africa
Middle East
Asia/Pacific
5.6 Revenue per Customer (EUR)
*
5.7 CAC (Customer Acquisition Cost) per customer (EUR)
*
5.8 Average Gross Margin per Customer (EUR)
*
5.9 Sales Cycle per Customer (months)
*
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Market(s)
6.1 Estimated Total Market Size (EUR)
*
Answer 0 if unknown
6.2 Top Competitor #1
*
6.3 Top Competitor #2
*
6.4 Top Competitor #3
*
6.5 Top Challenge #1
*
6.6 Top Challenge #2
*
6.7 Top Challenge #3
*
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Company Financials
7.1 Revenues - Past fiscal year (EUR)
*
7.2 Projected Revenues - Current fiscal year (EUR)
*
7.3 Projected Revenues - Next fiscal year (EUR)
*
7.4 Current annual rate of expenditure (EUR)
*
7.5. Current monthly burn rate (EUR)
*
7.6 Estimated cash flow break-even in (year since today)
*
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6 or greater
7.7 Estimated number of customers at break-even
*
0
1-5
6-10
11-50
51-100
100+
7.8 Estimated Revenues in 5 years (EUR)
*
7.9 Estimated EBITDA in 5 years (EUR)
*
7.10 Estimated market-share in 5 years (%)
*
Answer 0 if unknown
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Funding
8.1 Number of past funding rounds (excluding current)
*
8.2 Date of Last Funding Round
*
-
Month
-
Day
Year
Date
8.3 Current Investors
*
Founders
Accelerators
Angels
Friends & Family
Private Investor
Venture Capital
8.4 Number of Shareholders
*
8.5 Percentage of shares held by founders (%)
*
8.6 Last Valuation (EUR)
*
8.7 Current fund-raise volume (EUR)
*
8.8 Committed volume (EUR)
*
8.9 Pre-money valuation (EUR)
*
8.10 Expected number of future funding rounds
*
Excluding the current one
8.11 Expected total future volume (EUR)
*
8.12 Expected use of funds #1
*
Shareholder Buyout
Refinancing
Product Development
Organisation
Capital Expense (CAPEX)
Working Capital
Personnel
Sales
Marketing
8.13 Expected use of funds #2
*
Shareholder Buyout
Refinancing
Product Development
Organisation
Capital Expense (CAPEX)
Working Capital
Personnel
Sales
Marketing
8.14 Expected use of funds #3
*
Shareholder Buyout
Refinancing
Product Development
Organisation
Capital Expense (CAPEX)
Working Capital
Personnel
Sales
Marketing
8.15 Please add your most recent pitch deck
Browse Files
Please name your file as follows: Your Company Name_Deck_Current Year - example SuperStartUp_Deck_2019
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Information Consent
Would you like to become a member of the Basinghall Innovation Circle, our innovation platform which actively connects our industry partners and startups? - The Participation is free of any charge, you will be a visible member which allows us to connect you with interested partners and/ or potential customers wherever it is applicable
Yes
No
I consent to Basinghall Partners using the information collected through this form
*
Yes
No
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