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Altria Enterprises Submission Form
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Submittal Release and Confidentiality-Waiver Agreement
Acknowledgement
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Acknowledgement
No
Acknowledgement
Yes
First and Last Name
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Date
First Name
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Last Name
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Title
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Email
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Phone Number
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Company Name
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State of Incorporation
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Address
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City
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State
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Zip Code
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Company Website / URL
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Year Founded
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Diverse Business Owner Classification
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Other Classification
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AttachAdditionalInfo
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Non-confidential description of the company, business opportunity, and industry operated in
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Number of Employees
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Investment Amount Sought and Equity Stake (i.e., $100,000 for 10%)
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Current Company Valuation
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Prior Funding History
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How does the business intend to use the funds to grow?
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Are there any ways the business currently supports or contributes to its local community?
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Prior Year Revenue
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Prior Year Net Income
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Current Year Revenue
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Current Year Net Income
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AttachDiverseClassificationProof
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Optional: Upload any additional information (i.e., pitch deck, detailed capitalization table, governance document, financial forecast)
