Please provide information necessary for BIG (Bi-State Investment Group) members to screen applications for possible funding.

Fill out the following, providing brief, yet concise, responses. You may find it more efficient to cut and paste from your business plan.

Please limit your responses to 5 pages.

If you have additional information to submit, please email it to Joe Kessinger.
GENERAL COMPANY INFORMATION
 
  Company Name:
  Company Address:
  City:
  State:
  Zip Code:
  Company Structure:
  5-word Description:


COMPANY CONTACT INFORMATION
 
  Principle Contact Name:  
  Contact Phone Number:  
  Contact Fax Number:  
  Contact Email Address:  
  Company URL:
 

Provide a brief history of the business and why you are uniquely qualified to succeed. What are your biggest risks?:
 
 
  Describe the product/service being developed and offered. Also address the market need or opportunity for the product/service and why customers will buy your product/services. How does your product add value to the consumer? Describe the potential for future products/services:
 
 
  Describe the uniqueness of your product/services. Why is it better than the competition? Address any intellectual property components. Is the product patented or patentable?
 
 
  Describe the market: market size, key competitors, barriers to entry, trends, etc:
 
 
  Describe how you plan to market, sell, and promote the product/service. Include what marketing channels (direct, indirect, etc.) will be used:
 
 
  Describe financial projections, historical results (if any), break-even timeline, etc. Demonstrate how you derived your revenue (What is the revenue model? How do you make money?). Also, please include 3-year financial projection data, including revenues, expenses, gross profits, net income, assets and equities.
 
 
  Summarize the management and experience of the management team and board of advisors. Has any founder or key employee, within the past ten years, filed for personal bankruptcy? Has any founder or key employee ever been charged with a crime, other than a misdemeanor traffic offense? Include any other information about your management team’s qualifications as you see fit:
 
 
  Describe at least two different exit strategies for your investor(s) (How will the investors realize a significant return on their investment?):
 
 
  Describe the capital needs of the business, including the amount of funding needed and a summary of uses. Do you have a proposed structure and valuation? Describe what previous funding you have received, if any, when, how much, at what valuation and from whom. Who currently owns the stock of the company and how much?
 
 
  To the best of your knowledge, are any BIG members affiliated with your company or do you know or have a relationship with any BIG members? If yes, please explain.
 
 
  By submitting this Application to the Bi-State Investment Group (BIG), you acknowledge that all information is true and accurate. You also acknowledge that this information may be disseminated to all members of BIG.