Yard Labs Intake Form
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Company name: *
Name:  *
Title:  *
Email:  *
Phone:  *
Organization type (e.g.,  academic, foundation, joint venture, not-for-profit, for-profit corp., other): *
Company website:  *

Company location (city, state, country):

 *

Is the company registered to do business in the State of New York?

 *

Year founded:

 *

Is your company a women- or minority-led business? 

 *

Do you have any business certification? (Check all that apply)

 *
Required

Funding your company has raised to-date (dollar amount):

 *
Total number of employees:  *

Please describe your company, and your product or service:

 *

What differentiates you from your competitors?

 *

What phase of development is your product or service in? (e.g, idea, minimum viable product, prototype, certification, commercial deployment):

 *

Describe your customer base (if applicable):

 *

Have you conducted any previous pilots? If so, please describe the pilot:

 *

Has your organization received any awards or accolades?

Please briefly outline the pilot you are looking to conduct and its intended outcomes:

 *
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