ATCprequal

Angel Tax Credit Individual Application

The purpose of this form is for LaunchTN to verify that an applying company meets the pre-qualification requirements to be eligible for the Tennessee Angel Tax Credit program.

For more information regarding the program and eligibility criteria, please refer to the "Qualifying Businesses" section of the FAQ page on the LaunchTN website.

Application Date

Company Name*

Federal Employer Identification Number (FEIN)*

Parent Company (if applicable)

Company Address*

Address Line 1

Address Line 2

City

State

ZIP Code

County*

Primary Contact*

First Name

Last Name

Title*

Email*

Office Phone*

Mobile Phone*

Primary Contact - Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Name of CEO*

First Name

Last Name

Email*

Date of Birth (DOB)*

Date of Incorporation or Organization*

Company Description (100 words or less)*

Web Presence / Social Media

Website

Twitter

if applicable

Facebook

if applicable

AngelList

if applicable

Crunchbase

if applicable

Company Information

Please attach an executive summary (must be 2 pages or less).*

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Executive Summary

Does the company have an up-to-date pitch deck for investors? If yes, please attach below:

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Investor Pitch Deck

Describe the company's market opportunity (size, velocity, potential for disruption)*

What is your product / solution?*

Describe your business model: Who is your customer? What is your customer acquisition plan? How do you earn revenue?*

Have you received small business innovation research or small business technology transfer (SBIR/STTR) funding?*

Please attach supporting documentation.*

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Are you commercializing technology developed at a research institution in Tennessee?*

If yes, what institution?*

Please attach supporting documentation.*

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Please provide revenue by year since date of inception below:*

Revenue Self-Certification*

I certify that the revenue figures above are true and accurate to the best of my knowledge and do not exceed $3,000,000 annually

Current number of full-time employees (working 37.5 hours or more per week):*

Please prepare and attach a document listing all full-time employees, each of their home addresses, work locations, and whether they perform the majority of their job duties within the state of Tennessee.*

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Is the company engaged in a business involving any of the following?

Construction
Leisure
Hospitality
Retail
Real estate
Insurance
Banking
Lobbying
Consulting
Alcohol
Gambling

Yes / No*

For any “yes” answer, please provide additional details in the space provided:*

Has the company ever merged with, or acquired, another company?*

Please provide the date, a brief description, and attach any supporting documentation below:*

Supporting documentation, if applicable.

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Has the company ever operated under a different name?*

Please explain.*

Organizational Documentation

Please attach the following:

Organizational documents (Articles of Incorporation for a corporation or Articles of Organization for a limited liability company)

Organizational Documents*

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Please attach the articles of incorporation or organization for your company

Signature*

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Use your mouse or finger to draw your signature above

Name*

First Name

Last Name

Title*

How did you hear about the angel tax credit?