"Where IT Meets IR"

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Submit Policy/Preliminary Assessment Intake Form

"PLEASE NOTE: Submitting this form does NOT constitute being a contractual client"

(1) Are you a 1st time caller or an existing client?

(2) Your Name:

(3) Company Name:

(4a) Street Address:

(4b) City: State: Zip:

(5) Phone:

(6) Email Address:

(7) Have you read our website/blogfeed/facebook page that pre-answers most questions on our focus & policies, customer service options, opt-in rates, how long does it take, etc?

(8) In 3 to 4 paragraphs, what is your goal?

(9) If you were a contractual client, what are you authorizing us to do
based on our customer service options? (click here and choose)

(10) Specify what type of capital your seeking (if applicable) and how your eligible.

(11) What "skin in game" do you have? List revenue, patents, purchase orders, own equity, etc.

(12) How long have you been seeking capital?

(13) How many times have you already rejected capital sources terms sheets or have been rejected by capital sources? (if applicable)

(14) What's your deadline?

(15) Do you realize timelines to close differ significantly based on type of capital your pursuing?

By checking this box, you acknowledge that submitting this form does NOT constitute being a contractual client. Check this box ONLY if you accept these terms.

Other Usefull Information

(a) DOC's required to close

(b) HOW LONG does it take?

Todays date is:

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