Name

First Name

Last Name

Subject

Message

What are you looking for from EngineBloc?

How many people on your team? (please only include full time employees)

How much capital have you raised? (please provide in USD)

If you have raised capital, from whom did you raise the capital? Please include the following: (1) the name of the fund(s) that you raised from (2) "angels" (3) "family and friends" (4) "self investment". If it is more than one, please describe amounts from each.

How much are you currently raising? If investors have committed capital to your current raise, how much? *

Please provide a link to your investor deck. (Make sure the document is open to anyone with the link (not restricted access), whether it is a Dropbox or Google Drive link.)

http://

Please explain the traction your company has achieved to date.

Please confirm that you are aware that EngineBloc takes a small equity stake in addition to a monthly fee (to be agreed upon during the selection process).

Yes, I understand

No, I do not understand