Funding Request Questionnaire - Innovation Capital Management

Funding Request Questionnaire

In order to assist us in determining your capital needs, it is necessary for us to learn more about you existing operation or about your newly planned operation. Please answer the following questions as they apply to the best of your ability. The more accurate and complete your answers the better our assessment of your needs.

Business Name

Address

City, State, ZIP Code

E-mail Address

New or Existing Business?
New Business Existing Business

Number of Subscribers

Wired Subscribers

Wireless Subscribers

Number of Access Points

Coverage (In Homes Passed)

Technology Utilized (Motorola, Trango, etc)

Number of Employees

Billing System

Marketing Methods

Approximate Gross Sales

Approximate Funds Needed

Projected Number of Subscribers

First Year Projection

Second Year Projection

Third Year Projection

Number of Access Points

Projected Coverage (In Homes Passed)

Technology Utilized (Motorola, Trango, etc)

Number of Employees

Planned Billing System

Planned Marketing Methods

Estimated Gross Sales

Approximate Funds Needed