MAC Xcelerator Program Application for Admission | Midlands African Chamber, Inc.

MAC Xcelerator Program Application

Business Information

Business Name

Please select what best describe your business

Startup Business (in operation less than six (6) months)

Existing Business (in operation more than six (6) months)

Form of Ownership

Limited Liability Company (LLC)

Partnership

Sole Proprietor

Corporation

Date the business was established

Businness Address

Address

City

State

Zip Code

Website URL Address

Business Facebook Page

Business Linkedin Page

Business Instagram Page

Company representative

First Name

Last Name

Phone Number

Alternate Phone Number

More about your business

Nature of business – include a brief description of the product/service and the nature of your market. What differentiate you from the competition. Submit product brochures, links to social media sites, and any other company literature.

Customer segment served

Goals for joining the accelerator

Upload Certificate of good standing from the Secretary of State’s Office

Upload a 90 second Elevator Pitch Video

Upload Headshot of the company’s CEO

Upload bio(s)

Current status or stage of development of business: (e.g. working on prototype, produce in advanced development, etc.)

Current sales revenue (dollar volume per month)

What is your gross annual revenue? (dollar volume per year)

What is your gross annual revenue?

Number of employees (include principals)

Part Time

Full Time

Projected Number of employees in 12 months

Part Time

Full Time

Projected Number of employees in 24 months

Part Time

Full Time

Is this your primary business?

Yes

Is this your original concept?

Yes

Is at least 51% of the business owned and controlled by a woman?

Yes

Is your business currently licensed or registered in the State of Nebraska or Iowa?

Yes

Is at least 51% of the business owned, and controlled by an ethnic minority and please specify which one.

Yes

please specify which one

Do you have any investors or partners?

Yes

Type of financing used to operate a business to date

Venture Capital Firms

Private Investors

Personal Resources

Other

Status of Business Plan

Completed (please attach a copy)

In preparation and available by

Not yet started

Date Available

Attach copy of a business plan and summary, project literature if available

Please explain what services you or your organization can offer other clients of the MAC Xcelerator Program

Other relevant information

Note: Please make sure you have attached a business plan and summary, project literature, a certificate of good standing, and management biographies above. Please only share non-confidential information.

I understand the MAC Xcelerator Program is designed to support the Midlands African Chamber emerging businesses to succeed and thrive. Participating in the MAC Xcelerator Program necessitates interaction with the assigned mentor, attendance at educational and networking sessions, and reporting to the Midlands African Chamber on business changes. Once selected as a MAC Xceleratorparticipant, I must become a member of the Midlands African Chamber.

By registering and participating in this program, I consent to the recording of my likeness, image and/or voice and authorize the Midlands African Chamber to use photographs, videos, and audio recordings containing my likeness, image and/or voice in any medium for any purpose.

I agree to the terms and conditions of the MAC Xcelerator Program Program.

Applicant Name and Signature

First Name

Middle Name

Last Name

Applicant’s Title

Signature

Date