Pre Assessment Form

This is the first stage of your application. This pre-assessment form gives us an idea of your business and the best approach to take in carrying out our investment plans. Please make sure you read the investment criteria before filling the form

Name *

First

Last

Email *

Phone *

Gender *

Male
Female

Registered Business Name *

Business Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Are you the business owner and substantially involved in running the business? *

Yes
No, I have prople working for me

Number of Employees *

1-5
5-10
10-100

Select sector of business *

Please specify business sector (If not listed above)

Describe your business *

Less than 200 words

How much capital do you need? *

We offer between 500k - 10M

Are you looking for medium to long term finance between 1 to 3 years to grow your business? *

Why do you think we should invest in your business? *

Less than 200 words

Phone

Pre Assessment Form

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