Basinghall - Register of Interest

Register of Interest
1.1 Company Name *
1.2 Company Address *

Street Address

Street Address Line 2

City

Postal / Zip Code 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

Browse Files
Please enter a Dropbox or other URL link to your files. All image file formats accepted. Cancel of
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

Company Core Team
3.1 Number of Employees *
3.2 Have any of the founder(s) left? *
3.3 How long has the founding team been working together (in years)? *
3.4 Have any of the founders established a company before? *
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? *
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? *

Company Technology
4.1 Does the company develop its main technology and/or its own technology platform? *
4.2 Where is development done? *

In-house
4.3 Does the company own intellectual property (IP) patents related to its technology? *
4.4 Does the company make use of intellectual property (IP) licensed by external companies? *
4.5 Who is the licensed provider?
4.6 Is the license exclusive?
4.7 What is the duration of the license (in years)?

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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Register of Interest