Canadian Venture Capital Survey Form Contact Information Your Firm(required) Your Name(required) Your Email(required) Your Phone(required) Target Firm Information Firm Adress Firm Name(required) City, Province, Postcode(required) Web Address Telephone & Fax Date of Formation(required) Business Description(required) Target Firm Financial (Optional) Employees 0-49 50-99 100-499 500+ Assets $0-5M $5-25M $25-100M $100-500M $500M-$1B $1B+ Revenues $ nil $0-1M $1-5M $5-25M $25-100M $100-500M $500M-1B $1B + Deal Information - Canadian Deals ONLY Your Fund Name (if applicable) Disclosure(required) Full disclosure Partial disclosure (no $ amount) Confidential Series (required) not applicable Bridge Seed A B C D E F G H J + Close Date(required) Deal Size(required) Instrument(required) Common shares Preferred shares Convertible debenture Debenture Warrants SAFE Other Investor(s)(required) Funding breakdown* *Please provide breakdown of funding. The information will be kept strictly confidential and will be used in aggregate form only. For jurisdictions within Canada and USA, use the province or territory or state, otherwise use the country. For example, ABC raised $10M in Series A: $2M from 2 Ontario investors, $2M from 3 BC investors, $3M from 1 California investor, $1M from 2 New York investors, $2M from 1 South Korean investor. Deal Advisors Financial Advior(s) Legal Advisor(s) Authorization(required) YES, I am authorized to disclose this deal on behalf of my firm Type the characters(required) This field should be left blank Send Please wait... 2021-04-10
