Name *

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Last

E-mail *

Phone *

Address *

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City

State / Province / Region

Postal Code

Country

Have you formed as a legal business entity? *

Company Name or Proposed Company Name? *

Website / URL

What does your company do, or propose to do? *

Who has the problem you are trying to solve? *

How will you solve this problem? *

How will this business generate revenues? *

What is unique about your business or offering(s)? *

Can something be patented, or is something already patented? *

What type of patent do you have filed?

Patent #

What is your current status? *

Stage 1: Idea Formation (no revenues, no product or service for sale)
Stage 2: Prototyping & Launching (product or services is under development, no revenues)
Stage 3: Proof of Concept (product or services is available and is generating revenues)
Stage 4: Funding & Fundraising (ready for investment)
Stage 5: Growth Management (received investment and need help growing)

What type(s) of help do you think your startup needs right now? *

Upload Your Business Plan, Executive Summary and/or Pitch Deck

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Please upload these documents if you have them.

Additional Comments

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I understand by completing and submitting this form that I am NOT entering into a legal binding agreement with Zynergy Ventures, LLC. Also, I will not hold Zynergy Ventures, LLC liable for the information that is shared in this form. This information includes but is not limited to business ideas, business plans, concept drawings, patentable ideas, or any other information that might be deemed proprietary. I also understand and agree all information shared is either public knowledge, or is being disclosed to Zynergy Ventures, LLC at my own discretion. Have questions? Please read Why Startups Never Get Started

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