Success Talks Syndicate
Please complete this form submission in order for us to help you raise investment. We are focused on supporting entrepreneurs from black and ethnic minority backgrounds. There are four sections and the entire form should take no longer than 15 minutes to complete. All data is confidential and will only be shared with investors and judging committee.
Personal Details
All Data Is Confidential and Will Only Be Shared With Investors and Judging Committee
What is Your Name?
*
Title, First Name and Last Name
Primary E-mail
*
example@example.co.uk
Secondary E-mail
example@example.co.uk
Contact Number
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Company Registration Details
All Data Is Confidential and Will Only Be Shared With Investors and Judging Committee
Company Name
*
Year Founded
*
In Numbers Only e.g. 2015
Company Website
*
Your Role In the Organisation
*
Less than 50 characters
Company Legal Structure
*
Company Limited by Shares
Company Limited by Guarantee
Sole Trader
Limited Liability Partnership
Other
If You Selected "Other" Please State the Legal Structure
Is Your Business Registered in the UK?
*
Yes
No
Company Registration Number
Industry Your Company Is In
*
Artificial Intelligence
Aerospace
Agriculture
Beauty
Biotech
Business Services
Consumer Products
E-commerce
Education
Energy
Fashion
Financial Services
Food and Beverage
Gaming
Healthcare
Hospitality
Legal
Mobile
Media and Enetertainment
Music
Real Estate
Robotics
Security
Software
Sports
Transportation
Travel
Other
If cross-industry hold command and select multiple industry
If You Selected "Other" Please State the Industry
Business Twitter Name
Business Instagram Name
Business LinkedIn Profile
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Investment Requirements & Financial Details
All Data Is Confidential and Will Only Be Shared With Investors and Judging Committee
Amount of Investment You Require
*
£25,000 or Less
£25,001 - £50,000
£50,001 - £100,000
£100,001 - £150,000
£151,000 - £250,000
£250,001 - £500,000
£500,001 - £1,000,000
£1,000,001 - £5,000,000
Over £5,000,000
Desired Form of Investment
*
Equity
Debt
Convertible Note
Other
Is Your Business Revenue Generating?
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Yes
No
How Much Revenue Did Your Company Make Last Year?
*
In Pounds
What is Your Revenue Forecast for the Next Year?
*
In Pounds
Is Your Company Profitable?
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Yes
No
If No, When Do You Expect To Be Profitable?
Do You Have Up To Date Financial Information?
*
Yes
No
Does Your Business Have Compelling Intellectual Property?
*
Yes
No
How Will The Capital Be Spent?
*
300 Words Maximum
Have You Received Previous Funding?
*
Yes
No
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About Your Company
All Data Is Confidential and Will Only Be Shared With Investors and Judging Committee
Is Your Business 51% Or More Ethnic Minority Owned?
*
Yes
No
Prefer Not To Say
Do You Have A One Slide Executive Presentation, Pitch Deck or a Business Plan?
*
Yes
No
Number of Employees (Full Time and Part Time)
0 - 5
6 - 10
11 - 20
21 - 50
50 - 100
Over 100
Stage of Company
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Seed or Early Stage
Growth Stage
Mature
Describe Your Company in 10 Words
*
15 Words Maximum
Describe the Product or Service Provided
*
3 Sentences Maximum
Business Model
*
B2B
B2C
Both
Other
If You Selected "Other" Please State Your Business Model
What Traction Have You Had To Date?
*
75 Words Maximum
Who Are Your Customers/Clients?
*
75 Words Maximum
Who Are Your Main Competitors and What is Your Competitive Advantage?
*
100 Words Maximum
Please List Any Relevant Partnerships
100 Words Maximum
If You Have Received Formal Recognition or Awards Please Specify
100 Words Maximum
I would like to receive any queries/ information from Success Talks Or Their Investment Partners In Relation To My Application and Future Events
*
Yes
No
Upload Your Pitch Deck, Executive Summary, Financial Information and/or any Relevant Documents
Upload a File(s)
Max File size is 100MB
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