Pre-Screening Application

After completing this form, eligible applicants will be invited to complete the full application.

All fields with an asterisk (*) are required.


COMPANY INFORMATION
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INFORMATION FOR THE INDIVIDUALS (2 MAXIMUM) THAT WOULD REPRESENT YOUR TEAM AT THE ACCELERATOR IN SCOTTSDALE, ARIZONA DURING THE APRIL 22 – MAY 3, 2019 PROGRAM
Name (Individual 1) *
Name (Individual 1)
Phone (Individual 1) *
Phone (Individual 1)
Name (Individual 2)
Name (Individual 2)
Phone (Individual 2)
Phone (Individual 2)
ELIGIBILITY VERIFICATION
Have you raised at least $500,000 in seed capital? *
Are you generating recurring revenue? *
Please select a description for your company’s primary product or service *
Are you able to execute a participation agreement and provide $50,000 in participation fees (payable as cash or a convertible note) if selected? *