Palm Springs Incubator Application for Admission (Confidential)
3111 E. Tahquitz Canyon Way Palm Springs, CA 92262 p: 760.340.1575 f : 760.548.0370 w: cvep.com
Business Name *
Your answer
Representative/Title *
Your answer
Business Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Telephone *
Your answer
Fax
Your answer
Email *
Your answer
Website
Your answer
Company Type
Date Business Established
MM
/
DD
/
YYYY
Location of Business (City and State)
Your answer
Nature of Business - Please provide a description of the product/service. Include your intellectual property position (patents, trade secrets, copyrights or trademarks). Submit brochures and company literature if available. Please attach additional pages if needed.
Your answer
Describe the customer problem or need that your product or service solves. To what markets are you going to sell? List the potential market sizes, if known. Please attach additional pages if needed.
Your answer
Current status of development (working on prototype, idea stage, product or service in pilot stage, etc.). What are the near term activities and key milestones that are required for the development of the product or service? Please attach additional pages if needed.
Your answer
Who are your competitors? List them and briefly discuss how your product or service differs. Please attach additional pages if needed.
Your answer
Investment to Date
Your answer
Current Revenue (dollars/month)
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Number of current employees (including principals)
1
2
3
4
5
6
7
8
9
10+
Full-Time
Part-Time
Projected number of employees in 12 months
1
2
3
4
5
6
7
8
9
10+
Full-Time
Part-Time
Types of financing received to date (include the funding source, the dollar amount and use of the funds). Please attach additional pages if needed.
Your answer
Status of Business Plan
Please include the following items with your completed application:
How did you hear about the PSiHub
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Applicant Name/Title *
Your answer
Please send complete application package to: Attn: PSiHub Client Application 3111 East Tahquitz Canyon Way, Palm Springs, CA 92262 Or by email to Info@cvep.com
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