Apply for Assistance
Launch NY - Application for Assistance
Title *
First Name *
Last Name *
Company Name *
Job Title *
Address *
City *
State *
Zip *
Phone Number *
Mobile Phone
County *
Email Address *
How did you hear about us?
I was asked to apply for assistance by:
Industry Categorization *
Provide a brief (50 words or less) summary of your company/product/idea. Please indicate what is unique: *
Please check any of the following that apply to your business:
What stage is your business at? *
Is your product or service currently in market? *
How many customers do you have? *
How much cash has been invested in the business to-date? *
Please indicate sources of investment(s): (check all that apply) *
How much cash are you seeking at this time? *
What is your company's annual revenue? *
Are you interested raising money from outside investment sources, including venture capital and other funds? *
Are you involved with any other startup programs? *
If yes, which programs?
Have you applied for any COVID-19-related financial assistance, such as PPP or other programs? *
Including yourself, how many full-time employees work for the company? *
How many part-time employees or consultants work for the company? *
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