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Early Stage Company Application for Assistance

Step 1 - provide contact information

Company name:  
Street address:  
   
City:  
State:  
Zip code:  
Contact name:  
Contact phone:  
Contact e-mail address:  
   
Industry:
 
 for other, specify:
Brief description of problem being solved:  
Brief description of primary product or service:  
Brief description of primary Intellectual Property:  
Number of employees:  
Commercialization Phase:  
Current annual revenue:  
Requested funding for the next 12 months:  
What are the top three needs for your company (marketing, business, legal, funding, ...)?
1.
2.
3.
   
How were you referred to the Technology Tree Group?  
 
 Referrer's Name:
 Referrer's Company/Agency:
   
Was this technology developed from an SBIR?  
For SBIR-based companies:
 Granting agency:
 Grant year:
 Number of SBIRs granted:
   
   I agree to accept the non-disclosure waiver.

                      

 

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