Questionnaire

Please provide general contact information on your company:
Contact Name:
Business Name:
Street Address 1:
Street Address 2:
City:
State:
Zip:
Telephone Number:
Fax Number:
Email Address:

Please help us classify you new venture, place an "X" after the appropriate response under each question:

1. Type of Technology 
Health Care/Bio-Technology:
Communications or networking:
Computer software:
Computer hardware or peripherals:
Consumer product:
Internet related:
Service business:
Other (describe briefly): 

2. Channel of distribution 
Direct marketing:
Direct sales force:
Distributor/VAR/Manufacture's Rep:
Internet:
OEM:
Retail:
Other (describe briefly):

3. Customer type
Commercial or business:
Consumer:
Education:
Government:
Industrial:
Other (describe briefly):

4. Functional area(s) most critical to business success
Customer service:
Engineering or research and development:
Manufacturing or operations:
Marketing:
Sales:
Other (describe briefly):

Please provide the following information on your venture:

1. Current Funding Round
* Pre-money valuation:
* Funding round goal ($ you wish to raise):
* Funding round anticipated closing date:

2. Anticipated Next Funding Round
* Expected date of next funding:
* Expected amount of next funding:

3. Company Product or Service
* Description:

* Benefit/Problem it solves:

* Target customer:

* Competitive advantage:

4. Current Company Status
* Product Status (place an "X" after the appropriate response):
Organizing:
Developing product:
Beta testing:
In market/some revenue:
Other (describe briefly):

* Legal Status (place an "X" after the appropriate response):
Corporation:
Partnership:
Sole Proprietorship:
Other (describe briefly):

* Man-Months invested to-date by Founders:
* Current cash balance: 
* Current monthly revenues:
* Current monthly burn rate (expenses):

5. Liquidity Plan and Expected Date (If by acquisition, list several likely candidates):


6. Will you provide International Venture Partners Inc. with a Board of Director's Seat? (yes, no, maybe):


7. Will you provide International Venture Partners Inc. with a monthly income statement and cash position by the 15th of the following month?  (yes, no, or date to begin):


8. Will you provide International Venture Partners Inc. with a quarterly balance sheet by the 20th of the month following the quarter end?  (yes, no, or date to begin):

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!!! NOTE: Once you have completed this form please email it to plans@ivp2000.com !!!
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