Description
This application and questionnaire are intended to capture the principal characteristics of your venture.
______________________________________________________________________________________________________________________________________________________________________________
A Joint Venture of Maine & Company and Private Businesses
Phone: 207-871-0234 FAX: 207-775-6716 E-Mail: [email protected]
Maine Investment Exchange (MIX)
Entrepreneur Application for Investment Opportunity Presentation
This application and questionnaire are intended to capture the principal characteristics of your venture.
If you are selected to be a presenter, photocopies of your Executive Summary will be provided to attendees
of the Maine Investment Exchange Entrepreneur's Forum.
Instructions:
This application requires the submittal of the following items:
1. Completed Application/Questionnaire should be mailed to MIX along with your application fee of
$50.00. (Checks only - payable to Maine Investment Exchange)
2. The business plan must be emailed to MIX, preferably as a .pdf file. In addition, the one page
Executive Summary on page three of this application must be emailed to MIX. Note – the
business plan should have a more thorough Executive Summary than the form on page three.
3. Prepare a Cash Flow Statement spreadsheet with your historical (for existing companies) results for
the last two years and the Cash Flow Forecast for the next three years, with the first year by month.
(Please include this as an integral part of your business plan or an addendum to the plan)
Please Note: Companies selected to present at a MIX Forum will be required to pay an additional
$250. Payment will be required before the Forum.
Please give us the address at which you would like to receive correspondence:
Name:___________________________________________________ Title: ______________________
Name of Business: ____________________________________________________________________
Address: ____________________________________________________________________________
City: _________________________________ State: _________________ Zip Code: _______________
Telephone: __________________ FAX: ______________________ E:Mail: ______________________
My signature below signifies my interest in presenting at the next MIX forum. If accepted to present, I agree
to provide a two to three page executive summary to be used, in part or in total, at the MIX forum.
Signature:___________________________________________________________________________
How did you first hear about the Maine Investment Exchange (MIX) ?_____________________________
Mail Your Completed Application to:
Maine Investment Exchange
120 Exchange St., P.O. Box 7462
Portland, ME 04112-7462
______________________________________________________________________________________________________________________________________________________________________________
A Joint Venture of Maine & Company and Private Businesses
Phone: 207-871-0234 FAX: 207-775-6716 E-Mail: [email protected]
Maine Investment Exchange
Entrepreneur Questionnaire
Your responses to questions are critical to an
investor's decision to seek further information or
attend a MIX Entrepreneur's Forum. Please be
careful how you answer all questions.
***************************************
1. Which business or industry best describes
your venture? Check no more than TWO.
___ Agriculture/Fishing/Forestry/Natural Resource
___ Communications/Publishing
___ Computer Software
___ Education/Training
___ Fuel Dealers
___ Financial Services/Banking/Insurance
___ Manufacturing - High Tech Products
___ Manufacturing - Industrial and Commercial
___ Manufacturing - Consumer Products
___ Medical/Health Care
___ Real Estate/Construction
___ Recreation/Tourism
___ Retail Trade
___ Service - Technology Related
___ Service - Other
___ Transportation
___ Wholesale Trade
___ Environmental
___ Biotech/Pharmaceuticals
___ Other: _______________________________
2. Please indicate which category best describes
your venture. Check ONE only.
___ Seed/Start-Up - Venture in the idea stage or in
the process of being organized.
___ First/Second Stage - Venture that has been
organized and operating less than two years.
___ Third Stage - Venture that has been in
existence two to five years.
___ Established Firm #1 - Venture that has been
operating over five years and needs capital to
maintain growth.
___ Established Firm #2 - Venture that is over five
years old and in need of turnaround assistance.
3. Approximately how much capital do you need
to fulfill your immediate plans?
___________________________________
4. Is there a minimum investment you would
accept from any one investor?
Describe:____________________________
5. How much ownership are you willing to give
up? ____________________________
6. Please indicate which of these groups you
would like most to be matched with.
___ Professional venture capitalists,
corporations, other institutional investors.
___ Individual investors
___ Any of the above
7. Do you have a complete written business
plan? Yes ____ No ____
8. What are your actual sales and earnings before
interest & taxes for the last 12 months?
Sales $______________EBIT $_________
9. What are your projected sales five years after
receiving the financing you seek?
$ ___________________________________
10. How soon after financing will your operating
cash flow reach a break-even point?
________________________Months/Years
11. Would you be interested in management or
technical assistance in any of the following
areas?
___ Marketing
___ Production/Manufacturing
___ Finance/Banking/Capital Formation
___ Research and Development
___ Human Resource Management
___ General Management/Strategic Planning
___ Other
12. Assuming that an outside investor's training
and experience were appropriate, what role or
roles could such an investor play in
management of your venture?
___ No involvement other than reviewing reports
and attending stockholder meetings.
___ Representation on the Board of Directors
___ Providing consulting help as needed and
requested
___ Work part-time with the firm
___ Work full-time with the firm
______________________________________________________________________________________________________________________________________________________________________________
A Joint Venture of Maine & Company and Private Businesses
Phone: 207-871-0234 FAX: 207-775-6716 E-Mail: [email protected]
Industry:
Product(s):
Company Stage:
Number of Employees:
Management Team:
Estimated Market ($):
Financing Needed:
Exit Strategy:
Company Name
Type of Business
Executive Summary
Business Description: Concisely describe the business.
Product Description: Briefly describe the key products and why the products will
be unique in the marketplace. Describe what problem in the marketplace the
product/service solves.
Market & Competition: Briefly describe and quantify the market, and name the
key competitors. Detail what proof you have that someone will buy the
product/service ( i.e. contingent purchase orders).
Management Team: Briefly describe why the management team has the
necessary experience to be successful with this venture.
Funding Requirements & Use of Proceeds:
Contact:
President’s Name
Company Name
Address
Phone Number
Fax Number
Web Address
Email Address
Actual Proforma
Prior Year Year 1 Year 2 Year 3
Revenue
Gross Margin (%)
Expenses
Net Income
EBITDA
______________________________________________________________________________________________________________________________________________________________________________
A Joint Venture of Maine & Company and Private Businesses
Phone: 207-871-0234 FAX: 207-775-6716 E-Mail: [email protected]
Presentation Application
Process & Notes
Mail completed MIX Presentation Application with a $50 application fee.
The application will be pre-screened for any obvious problems and if rejected at that stage
all the materials will be returned including the application fee.
The application will be passed to the screening committee for reviews. If rejected, you
will be provided with a reason. If accepted, you will be notified and the application will
be reviewed by the MIX board to determine a presentation date. You will be provided at
least 2 weeks to prepare.
If accepted to present, you will need to submit $250 to the MIX Coordinator, 120
Exchange Street, PO Box 7462, Portland, ME 04112-7462.
The executive summaries will be handed out to the Forum attendees during registration.
You will be provided a table at the Forum to display any pertinent materials. It is
recommended that you have a few business plans available for serious inquiries. If
possible, it is recommended that you have more than 1 person available to answer
questions at the table.
Your presentation cannot exceed 10 minutes. No questions will be permitted such that
inquiries can be handled on a personal basis with you.
There will be approximately 45 minutes available at the end of the presentations to talk to
interested parties. Try to establish as many connections as possible for future follow-up.
Following the Forum, keep MIX informed of the success of your matching process so that
we can continue to improve. Keeping MIX informed of your success, or lack thereof, may
be of direct benefit to you in that MIX may be able to provide you with additional
contacts.
______________________________________________________________________________________________________________________________________________________________________________
A Joint Venture of Maine & Company and Private Businesses
Phone: 207-871-0234 FAX: 207-775-6716 E-Mail: [email protected]
Maine Investment Exchange
Notice to Companies & Investors
The Maine Investment Exchange (“MIX”) is a volunteer program operated by Maine & Company. Maine
& Company is a non-profit corporation organized under the laws of the State of Maine. MIX’s purpose is
to create a meeting place where businesses and business-owning and business-operating entrepreneurs (a
“Company” or “Companies”) and prospective Investors (an “Investor” or “Investors”) gain exposure to one
another (Companies and Investors are referred to collectively as “Participants”). It is not engaged in
selling, marketing or promoting, in any way whatsoever, the securities of any participant company. MIX
does not collect any fees for any transactions between Companies and Investors. MIX does not recommend
investment in any particular Company. MIX strongly advises and encourages all Participants to undertake
their own due diligence when considering any purchase or sale of securities and participating in any
financial arrangement. All Participants are advised to seek legal counsel to assure themselves they are in
compliance with all state and federal securities laws. Any information that may be provided by MIX to
Companies and Investors is not intended, and should not be relied upon, as a substitute for the recipient’s
own due diligence. MIX and Maine & Company make no representations as to the investment quality
of any Company about which an Investor may gain information through this website. MIX and
Maine & Company make no representations as to the degree of risk inherent in investing in any
Company or accepting financing from any Investor.
GENERAL DISCLAIMER
? MIX does not represent or endorse the accuracy or reliability of any of the information, content or
advertisements (collectively, the “Materials”) contained on, distributed through, or linked, downloaded
or accessed from any of the services contained on this website. You hereby acknowledge that any
reliance upon any Materials shall be at your sole risk.
? The Materials are provided by MIX on an “as is” basis, and MIX expressly disclaims any and all
warranties, express or implied, including without limitation warranties of merchantability and fitness
for a particular purpose, with respect to the Materials. In no event shall MIX be liable for any direct,
indirect, incidental, punitive, or consequential damages of any kind whatsoever with respect to the
Materials.
? In making an investment decision Investors must rely on their own examination of a company and the
terms of any stock offering, (the “offering”) including the merits and risks involved. Securities offered
by a company have not been recommended by any federal or state securities commission or regulatory
authority. Furthermore, the foregoing authorities have not confirmed the accuracy or determined the
adequacy of this website or any documents disbursed to an Investor in connection with any offering.
Any representation to the contrary is a criminal offense.
? MIX is a listing service for small corporate stock offerings. It is not a matching service. In addition,
MIX and Maine & Company do not function as securities broker-dealers, securities exchanges or
investment advisors and are not registered as such with the securities and exchange commission.
? MIX and Maine & Company have not made any investigation to verify the information provided by
Investors and make no representations or warranties regarding the truth, accuracy or completeness of
the information provided by Investors. Furthermore, MIX and Maine & Company have not solicited
any character or credit references respecting Investors.
? Each company must negotiate its own securities sales transactions with interested Investors and should
make its own investigation of each Investor’s financial condition and integrity.
______________________________________________________________________________________________________________________________________________________________________________
A Joint Venture of Maine & Company and Private Businesses
Phone: 207-871-0234 FAX: 207-775-6716 E-Mail: [email protected]
? All companies are encouraged to seek legal and other professional counsel prior to entering any
transactions with Investors.
? This website does not constitute any undertaking by MIX or Maine & Company to offer for sale or to
sell any securities or other interests in any Company.
? This website does not constitute an undertaking to sell any investment interests in a Company’s
venture. Any investment resulting from a listing on MIX shall be on a negotiated basis between the
Company and the Investor(s) without participation by or remuneration to MIX or Maine & Company.
? Each Company has agreed to make available, prior to the sale of any shares of stock to an Investor and
his representatives, if any, the opportunity to ask questions of, and receive answers from, a Company
concerning the terms and conditions of an offering and to obtain any additional information, to the
extent it possesses such information or can acquire it without unreasonable effort of expense, which is
necessary to verify the accuracy of any information provided to an Investor prior to the sale of the
shares of stock. Each Company has agreed to provide to an Investor all documents referenced but not
displayed in this website upon request therefor.
? An Investor and his representatives are encouraged to communicate directly with each Company. The
address and telephone number of each Company’s principal executive are stated herein.
PLEASE NOTE: MIX is designated to facilitate the flow of information between Companies and
Investors. MIX is not designated as a source or clients for consultants, brokers,
or others who charge fees for services to Companies. MIX and Maine &
Company will withhold their services from individuals and organizations who
are not acting as principals representing their own and/or partner’s interests.
Key Qualifying Criteria:
All applicants must meet the basic application requirements. However, selection to be invited to present at a
MIX Entrepreneur's Forum will be based on the review committee's overall evaluation of the following
criteria.
1. Clarity of written Executive Summary, application questionnaire and financial forecast.
2. The nature of the business venture and how convincingly the story is told.
3. Growth potential of the venture.
4. Knowledge of the customer and market demand for the product or service.
5. The full-time, year round employment opportunity presented.
6. The reasonableness of the exit strategy for the investor(s).
7. The potential for interstate commerce.
doc_869995052.pdf
This application and questionnaire are intended to capture the principal characteristics of your venture.
______________________________________________________________________________________________________________________________________________________________________________
A Joint Venture of Maine & Company and Private Businesses
Phone: 207-871-0234 FAX: 207-775-6716 E-Mail: [email protected]
Maine Investment Exchange (MIX)
Entrepreneur Application for Investment Opportunity Presentation
This application and questionnaire are intended to capture the principal characteristics of your venture.
If you are selected to be a presenter, photocopies of your Executive Summary will be provided to attendees
of the Maine Investment Exchange Entrepreneur's Forum.
Instructions:
This application requires the submittal of the following items:
1. Completed Application/Questionnaire should be mailed to MIX along with your application fee of
$50.00. (Checks only - payable to Maine Investment Exchange)
2. The business plan must be emailed to MIX, preferably as a .pdf file. In addition, the one page
Executive Summary on page three of this application must be emailed to MIX. Note – the
business plan should have a more thorough Executive Summary than the form on page three.
3. Prepare a Cash Flow Statement spreadsheet with your historical (for existing companies) results for
the last two years and the Cash Flow Forecast for the next three years, with the first year by month.
(Please include this as an integral part of your business plan or an addendum to the plan)
Please Note: Companies selected to present at a MIX Forum will be required to pay an additional
$250. Payment will be required before the Forum.
Please give us the address at which you would like to receive correspondence:
Name:___________________________________________________ Title: ______________________
Name of Business: ____________________________________________________________________
Address: ____________________________________________________________________________
City: _________________________________ State: _________________ Zip Code: _______________
Telephone: __________________ FAX: ______________________ E:Mail: ______________________
My signature below signifies my interest in presenting at the next MIX forum. If accepted to present, I agree
to provide a two to three page executive summary to be used, in part or in total, at the MIX forum.
Signature:___________________________________________________________________________
How did you first hear about the Maine Investment Exchange (MIX) ?_____________________________
Mail Your Completed Application to:
Maine Investment Exchange
120 Exchange St., P.O. Box 7462
Portland, ME 04112-7462
______________________________________________________________________________________________________________________________________________________________________________
A Joint Venture of Maine & Company and Private Businesses
Phone: 207-871-0234 FAX: 207-775-6716 E-Mail: [email protected]
Maine Investment Exchange
Entrepreneur Questionnaire
Your responses to questions are critical to an
investor's decision to seek further information or
attend a MIX Entrepreneur's Forum. Please be
careful how you answer all questions.
***************************************
1. Which business or industry best describes
your venture? Check no more than TWO.
___ Agriculture/Fishing/Forestry/Natural Resource
___ Communications/Publishing
___ Computer Software
___ Education/Training
___ Fuel Dealers
___ Financial Services/Banking/Insurance
___ Manufacturing - High Tech Products
___ Manufacturing - Industrial and Commercial
___ Manufacturing - Consumer Products
___ Medical/Health Care
___ Real Estate/Construction
___ Recreation/Tourism
___ Retail Trade
___ Service - Technology Related
___ Service - Other
___ Transportation
___ Wholesale Trade
___ Environmental
___ Biotech/Pharmaceuticals
___ Other: _______________________________
2. Please indicate which category best describes
your venture. Check ONE only.
___ Seed/Start-Up - Venture in the idea stage or in
the process of being organized.
___ First/Second Stage - Venture that has been
organized and operating less than two years.
___ Third Stage - Venture that has been in
existence two to five years.
___ Established Firm #1 - Venture that has been
operating over five years and needs capital to
maintain growth.
___ Established Firm #2 - Venture that is over five
years old and in need of turnaround assistance.
3. Approximately how much capital do you need
to fulfill your immediate plans?
___________________________________
4. Is there a minimum investment you would
accept from any one investor?
Describe:____________________________
5. How much ownership are you willing to give
up? ____________________________
6. Please indicate which of these groups you
would like most to be matched with.
___ Professional venture capitalists,
corporations, other institutional investors.
___ Individual investors
___ Any of the above
7. Do you have a complete written business
plan? Yes ____ No ____
8. What are your actual sales and earnings before
interest & taxes for the last 12 months?
Sales $______________EBIT $_________
9. What are your projected sales five years after
receiving the financing you seek?
$ ___________________________________
10. How soon after financing will your operating
cash flow reach a break-even point?
________________________Months/Years
11. Would you be interested in management or
technical assistance in any of the following
areas?
___ Marketing
___ Production/Manufacturing
___ Finance/Banking/Capital Formation
___ Research and Development
___ Human Resource Management
___ General Management/Strategic Planning
___ Other
12. Assuming that an outside investor's training
and experience were appropriate, what role or
roles could such an investor play in
management of your venture?
___ No involvement other than reviewing reports
and attending stockholder meetings.
___ Representation on the Board of Directors
___ Providing consulting help as needed and
requested
___ Work part-time with the firm
___ Work full-time with the firm
______________________________________________________________________________________________________________________________________________________________________________
A Joint Venture of Maine & Company and Private Businesses
Phone: 207-871-0234 FAX: 207-775-6716 E-Mail: [email protected]
Industry:
Product(s):
Company Stage:
Number of Employees:
Management Team:
Estimated Market ($):
Financing Needed:
Exit Strategy:
Company Name
Type of Business
Executive Summary
Business Description: Concisely describe the business.
Product Description: Briefly describe the key products and why the products will
be unique in the marketplace. Describe what problem in the marketplace the
product/service solves.
Market & Competition: Briefly describe and quantify the market, and name the
key competitors. Detail what proof you have that someone will buy the
product/service ( i.e. contingent purchase orders).
Management Team: Briefly describe why the management team has the
necessary experience to be successful with this venture.
Funding Requirements & Use of Proceeds:
Contact:
President’s Name
Company Name
Address
Phone Number
Fax Number
Web Address
Email Address
Actual Proforma
Prior Year Year 1 Year 2 Year 3
Revenue
Gross Margin (%)
Expenses
Net Income
EBITDA
______________________________________________________________________________________________________________________________________________________________________________
A Joint Venture of Maine & Company and Private Businesses
Phone: 207-871-0234 FAX: 207-775-6716 E-Mail: [email protected]
Presentation Application
Process & Notes
Mail completed MIX Presentation Application with a $50 application fee.
The application will be pre-screened for any obvious problems and if rejected at that stage
all the materials will be returned including the application fee.
The application will be passed to the screening committee for reviews. If rejected, you
will be provided with a reason. If accepted, you will be notified and the application will
be reviewed by the MIX board to determine a presentation date. You will be provided at
least 2 weeks to prepare.
If accepted to present, you will need to submit $250 to the MIX Coordinator, 120
Exchange Street, PO Box 7462, Portland, ME 04112-7462.
The executive summaries will be handed out to the Forum attendees during registration.
You will be provided a table at the Forum to display any pertinent materials. It is
recommended that you have a few business plans available for serious inquiries. If
possible, it is recommended that you have more than 1 person available to answer
questions at the table.
Your presentation cannot exceed 10 minutes. No questions will be permitted such that
inquiries can be handled on a personal basis with you.
There will be approximately 45 minutes available at the end of the presentations to talk to
interested parties. Try to establish as many connections as possible for future follow-up.
Following the Forum, keep MIX informed of the success of your matching process so that
we can continue to improve. Keeping MIX informed of your success, or lack thereof, may
be of direct benefit to you in that MIX may be able to provide you with additional
contacts.
______________________________________________________________________________________________________________________________________________________________________________
A Joint Venture of Maine & Company and Private Businesses
Phone: 207-871-0234 FAX: 207-775-6716 E-Mail: [email protected]
Maine Investment Exchange
Notice to Companies & Investors
The Maine Investment Exchange (“MIX”) is a volunteer program operated by Maine & Company. Maine
& Company is a non-profit corporation organized under the laws of the State of Maine. MIX’s purpose is
to create a meeting place where businesses and business-owning and business-operating entrepreneurs (a
“Company” or “Companies”) and prospective Investors (an “Investor” or “Investors”) gain exposure to one
another (Companies and Investors are referred to collectively as “Participants”). It is not engaged in
selling, marketing or promoting, in any way whatsoever, the securities of any participant company. MIX
does not collect any fees for any transactions between Companies and Investors. MIX does not recommend
investment in any particular Company. MIX strongly advises and encourages all Participants to undertake
their own due diligence when considering any purchase or sale of securities and participating in any
financial arrangement. All Participants are advised to seek legal counsel to assure themselves they are in
compliance with all state and federal securities laws. Any information that may be provided by MIX to
Companies and Investors is not intended, and should not be relied upon, as a substitute for the recipient’s
own due diligence. MIX and Maine & Company make no representations as to the investment quality
of any Company about which an Investor may gain information through this website. MIX and
Maine & Company make no representations as to the degree of risk inherent in investing in any
Company or accepting financing from any Investor.
GENERAL DISCLAIMER
? MIX does not represent or endorse the accuracy or reliability of any of the information, content or
advertisements (collectively, the “Materials”) contained on, distributed through, or linked, downloaded
or accessed from any of the services contained on this website. You hereby acknowledge that any
reliance upon any Materials shall be at your sole risk.
? The Materials are provided by MIX on an “as is” basis, and MIX expressly disclaims any and all
warranties, express or implied, including without limitation warranties of merchantability and fitness
for a particular purpose, with respect to the Materials. In no event shall MIX be liable for any direct,
indirect, incidental, punitive, or consequential damages of any kind whatsoever with respect to the
Materials.
? In making an investment decision Investors must rely on their own examination of a company and the
terms of any stock offering, (the “offering”) including the merits and risks involved. Securities offered
by a company have not been recommended by any federal or state securities commission or regulatory
authority. Furthermore, the foregoing authorities have not confirmed the accuracy or determined the
adequacy of this website or any documents disbursed to an Investor in connection with any offering.
Any representation to the contrary is a criminal offense.
? MIX is a listing service for small corporate stock offerings. It is not a matching service. In addition,
MIX and Maine & Company do not function as securities broker-dealers, securities exchanges or
investment advisors and are not registered as such with the securities and exchange commission.
? MIX and Maine & Company have not made any investigation to verify the information provided by
Investors and make no representations or warranties regarding the truth, accuracy or completeness of
the information provided by Investors. Furthermore, MIX and Maine & Company have not solicited
any character or credit references respecting Investors.
? Each company must negotiate its own securities sales transactions with interested Investors and should
make its own investigation of each Investor’s financial condition and integrity.
______________________________________________________________________________________________________________________________________________________________________________
A Joint Venture of Maine & Company and Private Businesses
Phone: 207-871-0234 FAX: 207-775-6716 E-Mail: [email protected]
? All companies are encouraged to seek legal and other professional counsel prior to entering any
transactions with Investors.
? This website does not constitute any undertaking by MIX or Maine & Company to offer for sale or to
sell any securities or other interests in any Company.
? This website does not constitute an undertaking to sell any investment interests in a Company’s
venture. Any investment resulting from a listing on MIX shall be on a negotiated basis between the
Company and the Investor(s) without participation by or remuneration to MIX or Maine & Company.
? Each Company has agreed to make available, prior to the sale of any shares of stock to an Investor and
his representatives, if any, the opportunity to ask questions of, and receive answers from, a Company
concerning the terms and conditions of an offering and to obtain any additional information, to the
extent it possesses such information or can acquire it without unreasonable effort of expense, which is
necessary to verify the accuracy of any information provided to an Investor prior to the sale of the
shares of stock. Each Company has agreed to provide to an Investor all documents referenced but not
displayed in this website upon request therefor.
? An Investor and his representatives are encouraged to communicate directly with each Company. The
address and telephone number of each Company’s principal executive are stated herein.
PLEASE NOTE: MIX is designated to facilitate the flow of information between Companies and
Investors. MIX is not designated as a source or clients for consultants, brokers,
or others who charge fees for services to Companies. MIX and Maine &
Company will withhold their services from individuals and organizations who
are not acting as principals representing their own and/or partner’s interests.
Key Qualifying Criteria:
All applicants must meet the basic application requirements. However, selection to be invited to present at a
MIX Entrepreneur's Forum will be based on the review committee's overall evaluation of the following
criteria.
1. Clarity of written Executive Summary, application questionnaire and financial forecast.
2. The nature of the business venture and how convincingly the story is told.
3. Growth potential of the venture.
4. Knowledge of the customer and market demand for the product or service.
5. The full-time, year round employment opportunity presented.
6. The reasonableness of the exit strategy for the investor(s).
7. The potential for interstate commerce.
doc_869995052.pdf