Application for Admission to MCED

Contact Information

Last Name: *

First Name: *

Address 1: *

Address 2:

City: *

State: *

Zip Code: *

Phone: *

Email Address: *

Company Profile

Company Name: *

Current Company Mailing Address:

Address is same as above

Address 1:

Address 2:

City:

State:

Zip Code:

Phone:

How did you hear about the Maine Center for Enterprise Development (MCED)?:

(50 word limit)

Why do you want to join?:

(150 word limit)

What specific business assistance do you need from the Incubator?:

(150 word limit)

Describe your business idea:

(150 word limit)

What need are you meeting? How are you meeting it?:

What's new, interesting, or different about what you are doing?:

Today, how do people overcome the problem your solution will address? Why is your solution better?:

Why do you believe this is a huge market opportunity?:

Describe your company's stage of development (check one):

How will you make money from your product/service?:

Who are your competitors, and who might become competitors? Who do you fear most?:

Does the company have a business plan?

Does the company have a business plan?:

Yes, completed & available for review

No, not started

In process

If yes, please upload your business plan:

If in process, expected completion date:

Is the company licensed to do business in Maine?:

Yes

If the company is currently operating, what was the company's incorporation date?:

What is the current/proposed ownership structure of the company?:

Can your product/service be patented?:

Yes

Don't Know

Do you currently have contracts/orders for your product or services?:

Yes

Management Team

Bios:

Use this to upload a file containing bios for each member of your management team (if they aren't included in your business plan).

Please provide the name's of the management team members and a brief description of their qualifications:

Person 1

Name:

Experience:

Person 2

Name:

Experience:

Person 3

Name:

Experience:

Have any Officers or Directors ever been convicted of a crime?:

Yes

If yes, please describe:

Financial, Personnel & Facility Needs

Have you raised any outisde capital yet?:

$0 - $10,000

$10,000 - $50,000

$50,000 - $100,000

> $100,000

What is (will be) the source of the initial capitalization?:

Other:

What is the company's current employment level?

Full Time:

Part Time:

What is the company's projected employment level in 3 years?

Full Time:

Part Time:

If you are interested in obtaining space in the incubator facility, approximately how much?:

# of workstations

Approximate date of occupancy:

If you have any special requirements, please specify:

References: Please provide the following lists of references

Banking Institution: Name:

Banking Institution: Contact:

Accounting Institution: Name:

Accounting Institution: Contact:

Legal Institution: Name:

Legal Institution: Contact:

How did you learn about MCED?:

Electronic Signatures

Please check the box below if you agree with the following statement: *

I hereby attest that the above information is true and correct to the best of my knowledge and that I have not provided any false or misleading information in order to obtain a favorable decision on admission to the Maine Center for Enterprise Development (MCED) Incubator Program.

Compliance Agreement

MCED is unique in several ways. First space is temporary; it is intended to lower the cost of operation for a new, small business during the initial start-up phase. Second, it is a learning environment that encourages business owners to interact with one another and to meet with experts and advisors in the field of entrepreneurship. Third, the program provides professional assistance for new businesses to facilitate their successful development.

Therefore, the owner of a business in the MCED incubator program:

understands that space is temporary and continued occupancy at the center depends upon the progress of the company and the commitment of the owner to achieve progress;
accepts that periodic reviews of his/her company's progress will be made and that he/she may be required to submit information (such as financial statements or employment statistics and projections) to the MCED staff with which such progress can be measured (all information will be kept confidential);
agrees to begin work on a formal Business Plan (if not already done so) upon date of occupancy, with completion of the first full draft to occur within 90 days of occupancy;
intends to take full advantage of the learning opportunities provided by MCED such as Lunch & Learn, Seminars & Workshops, and Consultants/Mentors.

Please check the box below if you agree with the above statement(s): *

I have read and understand the above Compliance Agreement and, if I am offered acceptance in MCED, I agree to comply with the terms and conditions of the above Compliance Agreement.

Please indicate the type of membership for which you are applying

Affiliate Membership: $200/month or $500/quarter or $1800/year

Two hours of consulation per month
Discounted service provider rates
Access to member-only events
Use of conference room
Quarterly business review
Web listing & press opportunities
Access to capital opportunities

On-Site Membership: $250 - $450/month

One hour of consultation per week
Use of conference room
Access to member-only events
Web listing & press opportunities
Quarterly business review
Private office space
Access to capital opportunities

Affiliate Membership with interest in On-Site Membership

Same benefits as Affiliate Membership listed above
Indication of interest in On-Site membership.

Choose one:

Affiliate Membership

On-Site Membership

Affiliate Membership with interest in On-Site Membership

Date you hope to become an On-Site Member:

Application Checklist:

Completed Business Plan (uploaded above)

Resumes or bios of the management team and owners (if not in the Plan)

Completed Application

Expectations

There are nine key expectations that members must agree to prior to approval of membership. These expectations exist to ensure the mission of MCED is being achieved and to ensure a greater level of success for businesses. Please check next to each expectation to indicate an understanding of each:

Options:

Commitment to develop business plan within first 90 days of incubation

Meet with MCED Director no less than monthly

Regular participation in member-related activities (at least one networking/educational event per month)

Ability to meet financial obligations (six months of capitalization)

The business will be located within Maine

The business will launch within 6 to 24 months from program entry

Provide MCED with quarterly data on sales and number of employees

Identify milestones that will lead to graduation from MCED

Establish an advisory board and meet at least quarterly

MCED will actively assist in the development of your business and its capitalization needs. As a Member, you agree to provide MCED a negotiated percentage of venture capital raised, equity in the form of warrants issued or royalties from revenue (see description below).

Venture Capital
Funds invested in the company in exchange for an equity (ownership) position in the company. MCED and the member can negotiate a finder’s fee between 1% and 5%. Capital can come from individual investors, angel networks, or venture funds.

Warrants Issued
In exchange for assisting in the raising of capital, the member and MCED can negotiate a fair number of warrants (Warrants are the right to purchase shares issued by a company at a specific price within a specified time span) to be issued to MCED. This will provide MCED with an ownership position in the member’s company. The percentage of ownership typically ranges between 1% and 5%.

Royalties from Revenue
Royalties are a form of revenue sharing and are offered as a result of successful assistance in taking the members product to market. Royalties are also negotiated and range from 1% to 5% of sales over a given period of time (typically up to 5 years).

Please indicate your preferred method of partnership and explain the rationale. (250 word limit):

Explanation:

(250 word limit)

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