Intake Form

General Information

* indicates a required field

*Company Name:

*Address 1:

*Address 2:

*City:

*State:

*Zip:

*Primary Contact:

*Phone Number:

*E-mail Address:

Website:

How did you hear about NMCC?


Company Details

*Corporate Structure:

*Industry:


*Number of employees::

*Annual Revenue ($):

*Monthly Burn Rate ($):

*Investment Amount Sought ($):

*Use of Funds:

*Current Ownership (%):

*One Sentence Pitch:

*Business Summary:

*Management:

*Customer Pain Addressed

*Description of Product/Service:

*Target Market:

*Existing Customers:

*Sales/Marketing Strategy:

*Business Model (how does Company make money?):

*Competitors:

*Competitive Advantage: