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The closing date for applications is 7th November 2007
Programme Application Form
Name of Company: Email:
Address: Web Address:
Postcode: UK Company Registration No:
Telephone No: Date of Incorporation:
Mobile No: Position in company:
Fax No:    
Company Details
1) Which sector is your core business is in? (you may select more than one)
Creative Industries: (please specify)
ICT/Web Based Services: (please specify)
Telecoms/Mobile: (please specify)
Software/Digital Media: (please specify)

Other: (please specify)
2) Brief Description of your business (100 words max)
3) What stage is your company at?

Start up (pre-revenue)
Early Stage (product development, some revenue)
Expansion (company is breakeven/trading profitably)
4) What sources have provided financial resources to date?
(please tick all that apply)
Management Team
Friends and Family
Associate Business Angels
Venture Capital
Bank
Other Company(s)
Public Agency(s)
Other
5) How much funding has been put into the business to date ?
£
6) What has been your turn over in the last 12 months ?
£
7) Have you been profitable in the last 12 months?
Yes No
8) How much finance are you currently/soon to be seeking?
£
9) How many people do you currently employ?
Executive Summary
1) Business information
- Describe your core business:
- What is your business model? (how does your company make money?)
2) Product / Services
- What are the business's products or services and what do they do?

- What makes this product unique or special and why do customers buy it?

- Do you have intellectual property and is it protected? (please give details)

- How scaleable is your product? (please give details)

3) Management

- Describe your current management team?

- Do you have gaps in your team and what are your plans to fill them?

4) Market

- What is your target market?

- What is the size of this market?

- Where are your opportunities and market growth potential?


- Do you have any existing international markets?  If so – please specify.  If not,
do you have any plans or objectives to internationalise your products/services?
5) Competition

- Who are your main competitors?

- What differentiates your products/service from these?

- What are the limitations of your product compared to these?

6) Sales/Marketing

- What are your current sales/marketing channels?

- What is your plan to increase sales?

- What are the limitations on this?

7) Financial Projection

- What is your current revenue?
£

- What is your gross margin?
£

- What profit have you made?
£

- What is your projected growth/profit over the next year to 5 years?
£

Please comment on any risks associated in meeting these targets.

Equal Opportunities

As the Accelerator is funded by the London Development Agency and City of London, we are required to collect statistics about equal opportunities.  We would be very appreciative if you could therefore complete the section below.
1) Gender:
Male Female

2) Please tick the box which best describes your ethnic origin:
Asian / Asian British Black / Black British
Middle / Near Eastern Black / Other
White Other

3) Do you consider yourself to have a disability as defined under the disability discrimination act 1995?
Yes No
4) Please state the borough of London in which your company is located



Thank you for completing this application form.

Your application will be reviewed and selections made by November 9th 2007.
The 70 companies selected will be invited to attend our one-day workshop on November 16th.

Following the one-day workshop, applications will again be reviewed and 15 companies will be selected and taken through the intensive support section of the Accelerator programme.

If you have any problems completing this form, or require any further information, please e-mail info@cbaccelerator.co.uk