Client Questionnaire

If you're not sure how to answer required fields, please make a best guess. More accurate or appropriate answers can be resolved with follow-up visits.

To be considered for investments of risk capital and expertise, we ask that you complete the following questionnaire. Required fields are marked *.

Company Contact
Your Title:
Your Full Name:*
Your Position With The Company:*
Phone:*
Cell Phone:
Email Address:*	(E-mail)
Company Information
Company Name:*
Address:*
Address 2:
City:*
State:*
Zip Code:*	(ZIP Code)
Web site Address:
About My Company
Which Technology Area do you best fit?:*
What best describes the (Stage of Development) of Your Product/Service :*
Do You Possess Intellectual Property?:*	Yes No
What does your Product/Service offer the market place?:
What problem does your Product/Service solve in the market place?:
Additional Comments:
Company Dollar Status
Number of Full Time Employees:	(Integer) Numbers Only
Revenue Total For The Last 12 Months:
Capital Investment to Date:	(Float) Can Enter Decimal
Have You Received Other Investment Funding:*	Yes No
If Yes, Please Describe That Funding:
How Did You Hear About Rocket Ventures/RGP :
Previous Contact:*	Yes No
Do You Have A Business Plan:*	Yes No
Upload Your Business Plan: (Optional)		To Upload - Your Business Plan file must be a PDF or TXT file, 2 megs or less.

is a program of the Regional Growth Partnership	- info@rocketventures.org
The Regional Growth Partnership acknowledges the contribution of the State of Ohio, Department of Development and Thomas Edison Program, which provide funding in support of the Launch program.