Test Page - Plains Ventures

To inquire about Plains Ventures services, please complete the information below. A representative from Plains Ventures will contact you soon.

Company Name(Required)

Primary Contact Job Title(Required)

Primary Contact Name(Required)

Primary Contact Phone Number(Required)

Email(Required)

Street Address(Required)

Street Address 2

City(Required)

County *

State(Required)

ZIP Code(Required)

Any additional co-founders or key employees

How did you hear about us?(Required)

How did you hear about us? (Other)

Please answer the following questions to the best of your ability. DO NOT INCLUDE ANY CONFIDENTIAL OR PROPRIETARY INFORMATION.

Your Concept(Required)

Provide a short description of your concept in 280 characters or less.

New or Existing Business(Required)

Industry(Required)

Is your company woman-owned?(Required)

Is your company minority-owned?(Required)

Minority Type(Required)

Revenue

If the company is selling goods or services, what was the company's total revenue for the past 12 months.

Do you have a completed prototype or have you demonstrated the concept?(Required)

Describe your product or service in more detail(Required)

How can Plains Ventures help? (venture assessment, advisory services, debt or equity funding consideration)(Required)

How much funding being sought(Required)

Name

This field is for validation purposes and should be left unchanged.

Inquiry Form