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How Exciting!
Please complete the following form.
Potential Investor Form
This form is used to participate as an investor in one, several, or all of our incubation projects or startups.
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Name
*
First
Last
E-mail
*
Phone
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Have you invested in a startup before?
*
Yes
No
Startup is the term used for a new company that is usually less than 2-3 years old.
What venture or ventures are you interested in making an investment?
*
Rent Items - Peer-to-peer rentals
Urban Farm Space - Renting local farm space
Vertical Cubes - Renting high-tech storage units
Fresh Pasta Bar - Quick and Affordable High Quality Pasta
Why are you interested in investing in one, several, or all the companies we are incubating?
*
Are you an accredited Investor?
*
Yes
No
Note: An accredited investor is someone that has net worth of at least one million US dollars, excluding the value of one's primary residence, or have income at least
$200,000 each year for the last two years (or $300,000 combined income if married)
Are you affiliated with a financial institution such as a venture capital firm, private equity firm, bank, broker dealer, etc.
*
Yes
No
Company Name
Job Title
How much money are you looking to invest?
*
$25,000 - $50,000
$50,001 - $100,000
$100,001 - $250,000
$250,001 - $500,000
$500,001 - $1,000,000
$1,000,001 - 5,000,000
5,000,001 - 10,000,000
$10 million +
CroudFunding is typically used for seed capital only. Investments under $250,000 is typically applicable in seed and angel investment opportunities.
At what stage are you interested in making an investment?
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Seed Capital - Becoming Operational
Angel Investor - Building & Launching Initial Offering
Series A - Building Awareness & Marketshare
Series B - Continue to Build & Grow
Series C - Fuel Growth For Exit Strategy
Mezzanine Finance - Deal with Cash Crunches
IPO - Initial Public Offering
Risk to Reward tends to be the greatest for early stage financing, as less risk is assumed in later rounds of financing.
Terms & Conditions
*
I agree to Zynergy Ventures, LLC Terms & Conditions. I understand I have not yet entered into a binding agreement with Zynergy Ventures, LLC, and have only agreed to be evaluated as a potential investor for one of its ventures or funds.
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