EmailMe Form - 2016 Guayacán Venture Accelerator Application

EmailMeForm

General Information
Company Name *
Company Web Site
Phone *
### - ### - ####
Email *
Twitter
Facebook
Company logo

Add File

Please upload your company logo, preferably in vector format.
Physical Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
How did you hear about us? *
Executive Team
Identify up to three principal executives of the company.
Name *
First Last
Position *
Percent of Ownership *
Academic Institution *
Highest Degree Achieved *
Name
First Last
Position
Percent of Ownership
(if any)
Academic Institution
Highest Degree Achieved
Name
First Last
Position
Percent of Ownership
(if any)
Academic Institution
Highest Degree Achieved
*
I certify that 50% or more of the company's employees are located in Puerto Rico.
Operations
How long has your company been in operations? *
When was your company incorporated? *
Where was your company incorporated? *
Is your company currently exporting? *
Yes
No
If your answer to the previous question is YES, please indicate which countries you're currently exporting to:
Financial Data
If you are currently exporting, please indicate what percentage of your revenues comes from exports.
Has the company merged with another company in the past three years? *
Yes
No
If yes, what percentage of the growth reflected in the financial data below is attributable to the merger?
Has the company raised or received investment from: *
Crowfunding
Angel Investors
Venture Capital
Private Equity Funds
Other
2013 *

Annual Sales

Net Profit

Operating Expenses

Total Equity

Number of Full-Time Employees

Number of Part-Time Employees
2014 *

Annual Sales

Net Profit

Operating Expenses

Total Equity

Number of Full-Time Employees

Number of Part-Time Employees
2015 *

Annual Sales

Net Profit

Operating Expenses

Total Equity

Number of Full-Time Employees

Number of Part-Time Employees
Audited Financial Statement *
Please upload your last audited financial statement.
Business Information
Briefly describe your business. *
Description may include brief history of the company, a general description of your business model, your current operations, products and/or services and primary market.
Describe your company's growth opportunity. *
For example: beginning to export, expanding to new markets, modifying business model, offering a new product or service, etc.
What is your strategy for growth? How are you turning this strategy into action? *
(500 words max.)
What are your company's top three challenges? *

Challenge #1

Challenge #2

Challenge #3
Governance
Please indicate if your company has a board of advisors and/or a board of directors. *
Organizational Chart *
Please upload your most recent organizational chart.
Capital Requirements
What are the capital requirements needed to enhance your company performance? How are you planning to obtain this funding? *
(350 words max.)
Participant Information
The program cost covers the participation up to three company executives. Please provide the name, resume or biography for each of the executives that will be participating.
Executive 1 Name *
First Last
Resume or Biography *

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Executive 2 Name *
First Last
Executive #2 participant information
Resume or Biography *

Add File
Executive 3 Name
First Last
Resume or Biography

Add File
The program will be held every other weekend from August to December.

Do you anticipate that the entire executive team will be available to attend all modules? Please explain. *
(250 words max.)
Is there any additional information you would like to share?
(250 words max.)
*
I certify that all the information provided in this application is true and accurate to the best of my knowledge.

Annual Sales
Net Profit
Operating Expenses
Total Equity
Number of Full-Time Employees
Number of Part-Time Employees

Challenge #1
Challenge #2
Challenge #3

General Information

Executive Team

Operations

Financial Data

Business Information

Governance

Capital Requirements

Participant Information