This form is used by Entrepreneurs to apply for funding through the Youngstown Next Generation Fund, an Appalachian Investors Alliance Fund. This form will auto-save in your browser and can be reviewed before you submit it.

Please respond directly to each section.  Feel free to cut and paste from previously created content at your discretion.  Do not respond to sections with "see referenced document", as your application will not be processed.

IMPORTANT:

You will be required to provide the following documentation with this application:

Pitch Deck, Most recent Income Statement and Balance Sheet, Pro-Forma Financials (3 years minimum), Cap Table, Corporate Documents (Articles of Incorporation, By-Laws, Operating Agreement, Shareholder Agreement)

If you do not have the above documentation at this time, do not proceed with this application until completed.

Your application and associated materials may be shared with Funds across the AIA network of Funds.

Contact Information
For this section, please enter information for the primary contact person with which the Fund should communicate regarding this application.
Who referred you to apply to the Fund?
Company Information
Legal name of the company, as registered with the State of its Incorporation, in which the proposed funds will be invested?
Please enter the name of your CEO, even if entered above as the contact person.
Please enter the year in which the company started. Note: If the company has changed the State in which it is registered, the legal structure of the company and/or the legal name under which it is registered, enter the date for the ORIGINAL entity. Commentary in the "Other Comments/Information" section below regarding these changes is appreciated.
Choose the industry that best fits your business.
Location
Please provide your company's primary PHYSICAL address below:
County in which the business resides.
Enter the number of FTE's or equivalents.
Financing Information
$
What do you estimate the value of your enterprise prior to this funding round?
What do you estimate the value of your enterprise prior to this funding round?
YES or NO?
$
How much are you looking to raise?
Please choose the type of financing sought.
Summarize term sheet financial and control terms to include: per-unit or per-share price, interest rate, note maturity term, discounts, valuation cap, running royalty rate and royalty base, and governance provisions, as applicable.
Provide an itemized listing and summary description of the intended use of funds requested.
$
How much have you raised to-date?
Previous Investors *
Target Closing Date *
Business Information
Please respond directly to each section.  Feel free to cut and paste from previously created content or documents within your linked document repository at your discretion.  Do not respond to sections with "see referenced document", as your application will not be processed.
Briefly describe the business' value proposition to customers, to include the problem you have identified, your solution to the problem, and why this company was founded.
Business Stage *
Simple description of the product(s) or service(s) offered.
Status of key IP (patents or trade secrets). Technology transfer and/or licensing agreements in place or under negotiation and key terms, including assignment and/or outside claims on IP. Disclosure of existing or potential IP litigation.
Provide details of your go-to-market strategy, including sales channels, milestones, expected sales cycle, pricing and strategy, expected margins, and plans to scale.
Who are your customers and why will they buy your product/service? Include market structure and customer segmentation where applicable.
Summarize how you will stimulate demand and close business. Please differentiate, as needed, if you are planning a multi-channel business model.
$
What was your total revenue over the last 12 calendar months?
In comparison to your stated competitors, provide details of how your product/service is differentiated and how you intend to leverage identified strengths and opportunities while defending against weaknesses and threats.
Share any additional details that will help the fund to understand your company and why your company would make an excellent addition to its investment portfolio. Provide URLs and/or other information references that may be helpful in understanding your business.
Please provide http links to LinkedIn profiles for your top managers (4 maximum). Identify current gaps in the team and your plan to fill them.
Add the internet address (URL) of a Dropbox folder, Google Drive folder or similar cloud-based storage of company files.
Required Pro-Forma and Financials *