Venture Application Form

Please complete the following information form so that we can know more about you and your venture. Once completed please return to Summit VMS. New ventures will go through a review process and will be invited to participate in the Summit VMS program based on venture readiness and mentor availability.

(*) Indicates required field.

Your Venture

Venture Name*:

Date*:

Industry/Technology*:

Number of Employees*:

Mailing Address

Street Address*:

City*:

State*:

Zip*:

Venture Principals

List Primary Contact First

1. Name*:

Role in Venture*:

Email Address*:

Contact Phone Number*:

2. Name:

Role in Venture:

Email Address:

Contact Phone Number:

Referred to Summit VMS by*:

Venture Status

Stage of Venture (check all that apply)*:
Idea PhaseBusiness PlanBusiness ModelPrototypeSales/RevenueBreakevenPatent/IPExternal Funding

Business Idea/Description*
Please provide a brief (less than two pages) description of your business (or idea) and summarize its current status; it is ok to be very early in the process. Describe what it is you plan to do, who you think you will sell to, and why your product or service is useful or important. Tell us if there are any critical immediate issues you need help with. Also discuss the backgrounds and roles of the team members. Finally, it would be helpful if you can tell us what you hope to gain by working with Summit VMS.