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* Name of Company

Corporate Headquarters Location

* Street Address

* City

* State

* Zip

* What type of capital are you looking to raise?

These are guidelines. Pick the one that most accurately describes the stage of your business. We understand every point may not be met for each category.

Growth-Stage: Generally speaking, companies that are generating $3M+ in revenue run-rate, have already raised at least $5M in external capital, and are looking to raise $10M+ in the next 12-18 months.

Early-Stage Venture: Generally speaking, companies that are generating $250k - $3M in revenue run-rate, have raised <$5M in external capital, and are seeking to raise $2M - $10M in the next 12-18 months.

Seed-Stage Showcase: Generally speaking, companies that are generating less than $250K in revenue run-rate, have raised <$1M in external capital, and are seeking to raise $2M or less in the next 12-18 months.

* Name of CEO / Founder

* Email Address of CEO / Founder

* Phone Number of CEO / Founder

LinkedIn of CEO / Founder, if applicable

Other Founders / C-Suite Executives

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LinkedIn URLs of Founders

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Additional Email address for contact at company

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* Corporate Website

Company Twitter Account (if applicable)

* Have you been selected for Venture Atlanta previously?

Yes No
If yes: What year were you selected, and what stage (for example, showcase)

Company Overview

* Year Founded

* Industry

* Short description of Company and the problem you are solving

* Please describe your revenue model and go-to-market approach

* Please describe your target market, estimate of potential market size, and market growth rate

* Please describe the competitive environment

* Amount of Equity Capital Raised to Date (use gross dollars, and not $000s)

* Amount of Financing Sought in the Next 12 Months (use gross dollars, and not $000s)

* Existing Investors

* Number of Fulltime Employees

* Number of Parttime Employees

* Are you associated with an Incubator/Accelerator?

Yes No

* Names of Key Advisors (board members, advisors, mentors)

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Financial Information

* Please Summarize your Commercial Traction (<500 characters). If you believe revenue is currently not a good KPI for your business, please use this section to explain.

* Please list actual or forecasted revenue for each of the following years. This is net revenue for the full calendar year under generally accepted accounting principles (GAAP). Do not use bookings, cash received, run rate, annualized revenue, or any other non-GAAP measurement.

- Note 1: Please use gross dollars (as opposed to “000s” or “$mm”)
- Note 2: If your company has a business model similar to a marketplace business or payment processing business, please use net revenue as opposed to Gross Market Value or Gross Transaction Volume

2020 (A): [Field Only Permits Numbers, no letters]
2021 (A): [Field Only Permits Numbers, no letters]
2022 (F): [Field Only Permits Numbers, no letters]
2023 (F): [Field Only Permits Numbers, no letters]

* Please list actual or forecasted EBITDA for each of the following years.

2020 (A): [Field Only Permits Numbers, no letters]
2021 (A): [Field Only Permits Numbers, no letters]
2022 (F): [Field Only Permits Numbers, no letters]
2023 (F): [Field Only Permits Numbers, no letters]

Note: Please use gross dollars (as opposed to "000s" or "$mm")

* Please list your actual or forecasted annual recurring revenue (monthly recurring revenue x 12) for the following time periods.

12/31/2021 (A): [Field Only Permits Numbers, no letters]
06/01/2022 (A): [Field Only Permits Numbers, no letters]
12/31/2022 (F): [Field Only Permits Numbers, no letters]

Note 1: Please use gross dollars as opposed to "000s" or "$mm")

* What is your current monthly net cash burn rate (enter as negative figure unless generating positive cash flow enter as positive)?

Demographic Information

Venture Atlanta is committed to supporting a diverse group of entrepreneurs and founders. Participation in this section is optional; simply select “prefer not to disclose” when appropriate. This will in no way negatively impact your relationship with Venture Atlanta, or your chances of being selected to participate in the conference.

Venture Atlanta does not discriminate on the basis of age, disability, ethnicity, gender, gender expression, gender identity, marital status, national origin (ancestry), race, religion (creed), sex, or sexual orientation.

Race/Ethnicity

Gender Identity

* Do you identify as part of any other underrepresented group?

Yes No Prefer not to disclose

Other Information

* Name of Corporate Attorney & Firm

* Name of CPA Firm

* Name of Bank

* Where did you hear about Venture Atlanta?

* Please Upload Your Company’s Logo as a .jpeg, .eps or .png file

* Please Upload Your CEO / Founder’s headshot as a .jpeg, .eps or .png file

Please Enter the URL of a One Minute Unlisted (Not Private) YouTube Video of the CEO/Founder Describing the Company (this is optional, but highly encouraged)

I acknowledge that if my company is chosen to present at Venture Atlanta 2022, I will adhere to the guidelines/standards set forth by Venture Atlanta. These guidelines/standards include: attending entrepreneurs reception, mandatory company coaching, manning a table at the conference itself and meeting deadlines for all materials requested. Those companies who cannot agree to these terms, need not apply.

Check to Agree

Application for 2022 Conference

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