| 1) Which of the following groups best describes
your business? |
|
Start-Up |
Spin Off Company |
Early Growth Company |
|
Individual |
Small Business |
Medium Business |
|
Large Business |
Multi-National |
|
| 2) Number of employees (full and part-time)?:
|
| 3) If you are a company what date was your company
formed?:
|
| 4) Which Country was your company formed in?:
|
| 5) If you are a company, what is your business
registration number?:
|
6) Please select the type of Trading Business you are? |
|
Individual Or Sole Trader |
Listed Public Company |
Proprietary Limited Company |
|
Association |
Co-Operative |
Partnership |
|
Incorporation |
Non-Taxable Organisation |
Unlisted Public Company |
| Other:
|
7) Where are the majority of your business activities conducted? |
Locally:
Nationally (please specify):
Internationally (please specify):
|
8) What is the annual turnover of your business, if any? |
|
Nil (have no commenced trading / start up) |
Below $100,000 per annum |
Over $100,000 per annum |
|
Over $200,000 per annum |
Over $300,000 per annum |
Over $400,000 per annum |
|
Over $500,000 per annum |
Over $750,000 per annum |
Over $1 million per annum |
|
Over $2 million per annum |
Over $5 million per annum |
Over $10 million per annum |
9) What is the current capitalisation value of your business
and/or innovative idea?
|
10) Which of the following have been completed to enable your
business and/or innovative idea to access funding?: (i.e. private
equity, venture capital, etc - tick all that apply) |
|
Business Positioning |
Financial Modeling
& Capitalisation Strategy |
Strategic Business Plan |
|
Strategic Marketing Plan |
Strategic e-Commerce Plan |
Intellectual Property Strategy |
|
Offer Information Statement |
Market Research |
Information Memorandum |
| Other:
|
11) Which of the following areas do you require assistance
with? (tick all that apply) |
|
Business Positioning |
Management Skills |
Accessing Private Equity |
|
Research and Development |
Accessing Venture Capital |
Business and Marketing Development Planning |
|
Financial Modeling & Capitalisation Strategy |
Export Market Development |
Operational Development |
|
Commercialisation of Business/Product |
Product Development |
Project Management |
|
Capital Raising Management |
Other:
|
12) Do you own or have control of the intellectual property
(IP) and/or background for your product, service or process? |
|
Yes
No |
13) Has your business raised capital (either private or venture
) in the past? |
Yes
No
If yes, provide details:
|
 |
Business Information |
|
1) Please provide a short description
of your overall business and/or innovative idea;
|
2) What is your vision for you business
and/or innovative idea in the short term (next 2 years)?
|
3) What is your vision for you business
and/or innovative idea in the medium to long term (next 5 years)?
|
4) What is your competitive advantage?
(e.g what is it that your business does better then anyone else,
your unique selling proposition)
|
5) Please provide a brief history
of your business or how your innovative idea came about?
|
|
Funding |
|
1) What level of financial funding are you able to provide
to develop and grow you business and/or innovative idea? |
|
Nil |
Up to $5,000 |
Up to $10,000 |
|
Up to $20,000 |
Up to $50,000 |
Over $50,000 |
|
Over $100,000 |
Up to $250,000 |
Up to $500,000 |
|
Over $500,000 |
Up to $1 million |
Over $1 million |
2) How do you propose to fund this amount?
|
3) To access venture capital and/or private equity are you
prepared to consider giving up equity in your business and/or
innovative idea to allow it to grow and generate significant commercial
returns? |
|
Yes
No |
|
4) How much money do you wish to raise for
your project: $
|
