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Investment Questionnaire

To better assess how we can help you and your business succeed, please complete the following questionnaire.

Please note that the fields marked with a star (*) must be completed in order for the form to be submitted successfully.

We will review the information you provide and attempt to respond within two to four weeks. If you would like to contact us in the meantime, please direct all inquires via e-mail to info@vimac.com. Thank you for considering VIMAC.

Date:

Contact Information
* Company Name:
Web Address (if any):
* Street:
Floor/Suite:
* City
* State/Province
* Country
* Postal Code
* Your Name
Title
* Phone
Fax
* e-Mail
* How did you hear about VIMAC? Surfing the Web
Referral (if so, please give name):

Other (please specify):


About Your Business

What is your company's unique value proposition?

What are your company's key differentiators?

Please describe your product or service.

What is your target market, and how does your product/service meet the needs of this market?

Who are your target customers?

When was the company founded?

N/A (company in concept stage)

Total number of employees today:
Target number of employees in 6 months:
Development status of your product or service: Concept
Alpha
Beta
Shipping

First product or service delivery date:


About Your Finances
Revenue YTD:
Target break-even date:
Total capital investment to date:
Last round of investment: Date:
Amount:
Pre-money valuation:
Characteristics of the current investment you are seeking:
Current burn rate ($ spent/month):

Business Plan Executive Summary/Management Bios
Please copy and paste the executive summary from your business plan as well as biographies of your senior managers




Thank you for completing VIMAC's investment questionnaire.