Name of your startup / business? *

 
What year did you launch this business/product/service? *

 
What state do you operate from? *

 
What is the problem you are trying to address?
*

 
What is your solution to the problem? *

 
How many users do you have accessing your product/service? *

 
Number of people on the team: *

 
Link to app download/website if any

 
Founder's Full Name:
*

 
Gender:
*


 
Phone Number: *

 
Business Address: *

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