APPLICATION FORM

Please fill in the application form below. We will be in touch with you shortly.

Company Name *

Contact Name *

Contact Name

First Name

Last Name

Website *

http://

Email Address *

Phone Number *

What sector(s) does your company fall under? *

Check all that apply.

Blockchain

IoT/Data Analytics

Cannabis

FinTech

HealthTech

Consumer

Energy

Other

If "Other", then please describe below

Required if response was "Other"

What is your company's business model? *

If the business model is "Other", what is it?

Required if response was "Other"

Where is your company headquartered? *

How much are you looking to fundraise? *

Response required if you are looking for fundraising. Otherwise feel free to write N/A.

What is the minimum amount of funding you would accept from any ONE investor? *

Response required if you are looking for fundraising. Otherwise feel free to write N/A.

Will the fundraise be in the form of an equity or token sale?

Response required if you are looking for fundraising and your project is in the blockchain space. Otherwise feel free to leave blank.

How did you hear about NeonVest? *

If you heard about NeonVest via referral, who was it?

Response required if you received a referral.

Whitepaper / Presentation Materials / Other Documentation *