Investor Profile Form

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Investor Profile Form

The form can be filled out on-line or downloaded as a Word document (Investor Profile Form). The Word document can be faxed, mailed or emailed to UConn R & D.

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

How would you like us to contact you?

If by mail, give preferred address (if different from above):

If by phone, give preferred phone number:

Investment History 1. Are you registered with any Business Angels Networks? Yes No

2. Have you previously invested in non-public companies or partnerships? Yes No

3. What type of investor are you?

4. How much capital would you prefer to invest?

5. Have you previously invested in companies as a business angel? Yes No How Many?

Industries 6. In which industry sector(s) would you be interested in investing? (Please hold the Ctrl key and click to select all that apply.)

Investment Preferences 7. Which critical documents should be presented to you for initial evaluation of an investment opportunity? (Please hold the Ctrl key and click to select all that apply.)

8. Indicate preferred length of investment.

9. Are you geographically constricted in your investment criteria? Yes No

10. Please indicate geographic location(s) of interest. If other, please specify:

11. Indicate preferred stage of business. (Please hold the Ctrl key and click to select all that apply.)

12. Are you willing to invest alongside other investors (other than co-investors you may organize yourself) in the same company? Yes No

13. Indicate type of collaboration you would prefer.

14. Indicate the extent of your desired involvement with a company in which you invest.

15. Specify other/additional investment and funding criteria (i.e., industry group(s), sales, profitability, years in business, cashflow, etc.):

Management/Advisory Assistance 16. Indicate the type of management involvement you would like with a company in which you invest.

17. Are you interested in providing management and/or advisory assistance in any of the following areas? (Please hold the Ctrl key and click to select all that apply.)

General 18. How did you hear about UConn Research & Development Corporation?

19. Other comments, information, requests, instructions, etc.


		Facts for Investors

		Investor Profile Form

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