TechConnect WV TechWrx Application

TechConnect WV TechWrx Application

Tech Connect WV (TCWV) coordinates and collaborates TechWrx with its centers of excellence to provide an integrated continuum of direct technical assistance to inventors, entrepreneurs, manufacturers, and businesses seeking technology-driven solutions and opportunities. To be eligible for TechWrx support your business must first be located in one or more of the following West Virginia counties: Barbour, Boone, Braxton, Cabell, Calhoun, Clay, Doddridge, Fayette, Gilmer, Grant, Greenbrier, Harrison, Jackson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, Mason, McDowell, Mercer, Mingo, Monongalia, Nicholas, Ohio, Pocahontas, Preston, Putnam, Raleigh, Roane, Taylor, Tyler, Tucker, Upshur, Wayne, Webster, Wetzel, Wirt and Wyoming.

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Complete the Application below. TechConnect West Virginia (TCWV) will contact you soon.

Date

MonthDayYear

Name

First NameLast Name

Company Name

D.B.A. (Doing Business As)

EIN

WV Business Registration Account #

Business Structure

E-mail

Website

Business Phone

Area CodePhone Number

Mobile Phone

Area CodePhone Number

FAX

Area CodePhone Number

Physical Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Shipping/Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Disclosure (what is the product, service, business or other idea):

Upload Supporting Information or other File(s): (Up to 20MB per file). If you are unable to upload your file type please note in the "File Upload Comment Box" below. We will make other arrangements to receive your file.

Upload a File

File Upload Comments

Type of Company/Entity

Years in Business

Jobs Created

Jobs Retained

Anticipated Follow-on Financing (in addition to TechWrx)

Follow-on Financing Comments

New Business Formed?

Number of Business(es) or Business Divisions Formed

Name of Product, Service or Idea

Describe or Link Current or Anticipated Media Coverage

Region (Projects available for TechWrx assistance should be located in one or more of the grant service counties)

How did you learn about TechWrx?

Other

Please describe the benefits of your invention, idea or product in 50 words or less.

Stage of Development:

Time to Market

Intellectual Property Status

Estimated Sales Forecast

Size of Market

Value Improvement over Current Products:

Market Validation:

List existing competitors and/or competing products:

Are you seeking investment?

If so, how much?

What other assistance do you need?

By checking this box, it is understood that any information shared between the potential client and TechWrx will remain confidential.

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TechConnectWV TechWrx Application