• Home »
• Apply »
• Introductory Information Form

Introductory Information Form

Welcome to the Erie Technology Incubator. It is our pleasure to meet with you and to let you know the many benefits of ETI. Our desire is to guide and mentor scientists, technologists and inventors extraordinary toward a successful entrepreneurial experience.

Please assist us to better serve you by completing the brief questionnaire below.

Thank you,

Russell V. Combs
Executive Director, ETI

Company Information

Company Name
Company Address
Company Structure
Phone
Fax
Cell
Email	Please provide the best email address to reach you
Website	Please indicate if you don't have a Website

Company Principals

(1) Principal
(1) Company Position
(2) Principal
(2) Company Position
(3) Principal
(3) Company Position
(4) Principal
(4) Company Position

Business Information

Brief Business Description
Date Started	Applicable for existing business only
Where Started	Applicable for existing business only
Stage of development	Idea StageEarly StagePrototype Stage (manufactured and solid in small quantity)Development Stage (product maturity, sales volume, ...)Expansion Stage Applicable for existing business only
# Full Time Employees	Applicable for existing business only
# Part Time Employees	Applicable for existing business only
How is your product/service unique?
How is your product or technology protected?	Patent Trademark Trade Secret Trade Dress Copyright Other Please check all that apply
What currently is the primary source of financing for your business?	SavingsOperating CapitalEquity Investment - Informal/PrivateEquity Investment - Angel FundingEquity Investment - Venture CapitalDebt - PersonalDebt - Bank
Please list any / all legal actions, outstanding and pending, against the company or its officers

Demographic Information - Owner 1

Senior / Principal Owner

Gender	MaleFemale
Ethnic Representation
Veteran	YesNo
MWBE Certification	YesNo

Demographic Information - Owner 2

ONLY if multiple partners

Gender	MaleFemale
Ethnic Representation
Veteran	YesNo
MWBE Certification	YesNo

Apply

• Introductory Information Form
• Client Entry Policy