2019 FINTECH100
Please note: not all fields are required, but the more information you provide, the easier it will be for us to include you in the list if you qualify.
Email address *
Contact name *
(Full name and role in brackets, in case we have questions)
Your answer
Company name *
Your answer
Previous company name
(If company has changed its name in past 24 months)
Your answer
Company tag line
Your answer
Company description
(Paragraph describing what your company does)
Your answer
Company logo (link)
(Please provide a link to a high quality logo we can publish)
Your answer
Company image (link)
(Please provide a link to a high quality image we can publish. This could be a team photo, product photo, founders photo etc. See past reports to get an idea of what we look for.)
Your answer
Year company was founded *
Your answer
Location of global HQ *
(Country of global head office)
Your answer
Founding location
(Country where founded, if different to current global HQ location)
Your answer
Key people
(Please list any founders and the top three executives in the company along with their current roles in brackets)
Your answer
Notable investors
(Please list any key/note-worthy investors in the company)
Your answer
Short quote
(From a key person or investor in the company, that we can publish. Please attribute in brackets after the quote.)
Your answer
Company website URL *
Your answer
Fintech category *
(Please select your sector below or select 'Other' if none apply)
Ownership *
Number of employees
Total equity capital raised *
(How much equity capital investment has the company received since it was founded?)
Your answer
Total debt capital raised
(How much debt capital investment has the company received since it was founded?)
Your answer
When did you last raise equity capital?
(Year and month)
Your answer
Recent equity capital raises
(How much equity capital investment has the company received since 1 July 2018?)
Your answer
Recent debt capital raises
(How much debt capital investment has the company received since 1 July 2018?)
Your answer
Equity capital raises past 3 years *
(How much equity capital investment has the company received since 1 July 2016?)
Your answer
Recent debt capital raises past 3 years
(How much debt capital investment has the company received since 1 July 2016?)
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of H2 Venture Capital. Report Abuse - Terms of Service