Featured Company Presenter

*Featured Company gets an 10 minute presentation slot within an industry specific track at IMPACT 2013 on October 23

*Companies will be selected by September 6, Deadline to submit August 30

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Company Name:
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Company Contact:
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Company Contact Title:
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Address:
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City:
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State:
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Zip Code:
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Phone:
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Fax:
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Email:
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Website:

How did you learn about IMPACT 2013 and the Featured Company application?
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Please list the other capital conferences/angel fairs that you have presented at in the last 24 months:
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Please check the appropriate company industry

Technology Industries:
 Business Services Communications Computer Hardware Computer other Computer Software Construction/Bldg Energy FIRE (Finance, Insurance...) Industrial Internet Specific Manufacturing Nanotechnology Product Consumer Related Electronics/ Semiconductor Transportation Utilities

Technology OTHER:

Healthcare Industries:
 Biotechnology Diagnostics Drug Delivery Drug Discovery Health Care Health Care Services Medical Devices Pharmaceuticals

Healthcare Industries OTHER:

Other Industries:
 Consumer Cleantech Materials Energy Semi-conductor RFID Chemicals

## of Employees:
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Bank:
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Auditor:
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Law Firm:
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Boards

Board Members & Affiliations:
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Advisory Board Members & Affiliations:
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Short Biographies of Key Executives:
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Investment Information

Total Previously Invested (if applicable):
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Past Company Investors:
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Amount of Financing Sought:
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Use of Funds:
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Financials

EBITs and Revenues for 2012, 2013; and projections for 2014-2015; Revenue Model:

Pre-money Value-: (this information will not be published and will be used by the organizers to help in the proper classifications of your company)

Narrative Information

Summary of Business Description & Strategy:
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Products/Services:
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Technologies/Special Know-How:
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Target Markets:
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Distribution Channels:
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Competition:
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