ENTRETECH PWC ENTREPRENEURSHIP AWARDS 2008
Application Form
Please complete this form in full.
Please note that the information will only be shared with the Awards Selection Committee.
Nominee Company
*
Company Name
CEO
*
First Name
*
Last Name
*
Telephone
*
Email
Address
*
Street
*
City
*
State
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
DC
WV
WI
WY
*
Zip
*
Website
*
Date Founded
*
Number of Employees
Annual Revenues since inception
(calendar years ending):
Please complete for all years your company has earned revenue. It is required to fill out this
section as completely as possible. All information will be kept confidential to the Awards Selection Committee:
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008 (estimated)
Industry Sector:
*
Please select
at least one
category::
Aerospace and Defense
Internet Marketplace
Biotechnology and Bioinformatics
Media Technology
Digital Technology
Medical Devices and Diagnostics
Energy and Environment
MEMS (Micro-Electro-Mechanical Systems)
Engineering (e.g. Optical Engineering, Sensor Development, Robotics)
Specialty Chemicals and New Materials
Industrial Engineering and Instrumentation
Transportation
Information Technology (Software, Hardware, Internet, eCommerce)
Other
*
PLEASE DETAIL WHY YOU BELIEVE THAT YOUR COMPANY SHOULD BE SELECTED
(max 2000 characters):
*
PLEASE DESCRIBE YOUR PRODUCT OR SERVICE AND THE VALUE THAT YOU BRING
TO THE CUSTOMER
(max 2000 characters)
*
PLEASE DESCRIBE YOUR COMPETITIVE POSITION IN YOUR MARKET
(max 2000 characters)
PLEASE LIST SIGNIFICANT MILESTONES REACHED BY YOUR COMPANY THAT DEMONSTRATE
VALIDATION OF YOUR BUSINESS PLAN BY THE MARKET AND INVESTORS:
*
Capital Raised
*
Source:
Choose
Angels
VC
Government
Strategic
Intellectual Property
Strategic Partnerships
Research Contracts
Product Orders
Significant Customers
Revenue Milestones
Profitability Milestones
*
Nominee's name