Integrated Investments International

Venture Name:
Your Name:
Your Title:

Other key members of the team (Name, Title):

Email:
Phone:
Fax:
Website URL:

Address 1:
Address 2:
City:
State:	Zip:
Country (if other than US):

Other Location(s):

Industry:
Products or Services: (1 or 2 sentences)
Markets Addressed (main customer bases):
Date Established:
Ownership (current %, target %, or other basis):

Stage:	Seed -- organizing business plan and/or team
	Technical proof of concept
	Commercial proof of concept (current customers)
	Operating Startup
	Established Company seeking expansion
	Mezzanine finance
	Exit (Merger or Acquisition or IPO stage)

Corporate Purpose, Mission or Vision
Past Milestones Achieved: (indicate year)
Funding Status: (total amount invested to date)	$
Capital Requirements or Other Goal:	$
Use of Funds:

How did you hear about In³?:
Additional Comments (business model, values/philosphy, monthly burn rate, key competitors, alliances, etc.):

Venture Services