Intake Form We look forward to working with you! Please fill out this form with the relevant details to get us started: Leave this field blank Company Name Contact First Name Contact Last Name Title Name(s) of Founder(s): 0/250 Max characters Contact Information Phone Number Country code + Phone number Email Address Street Website https:// Business Information Date of Incorporation Please provide copy of Articles (optional) Accepted file types: Choose file Uploading… (0%) Browse Oops. A file with this name has already been uploaded. Oops. This file type isn’t allowed. This file size is too big. Delete 0/1 Files uploaded CRA Business Number Other Key Personnel (optional) 0/250 Max characters Number of employees and contractors (optional) Names of current employees and contractors (optional) 0/250 Max characters Has your company shipped a previous game? (optional) YES NO Would you like to tell us about it? (250 character limit perhaps?) 0/250 Max characters Have you raised any funds to date or have conditional agreements or applications out for financing? Examples: • OIDMTC • CMF • Mentorworks • Ontario Creates • Private Equity Agreements (ie. Espresso Capital) • Bank financing 0/250 Max characters What is the status of your current project and financing? (optional) Do you or your company belong to any special interest groups or other incubators? Examples: • Interactive Ontario • Youth Founder/ Co-Founder (18-29) • Female Founder/ Co-Founder • Foreign-born Founder/ Co-Founder • Visible Minority Founder/ Co-Founder • First-venture Founder/ Co-Founder • Other Venture or Start Up Incubators 0/250 Max characters Does your project have any ancillary integrations or focus? (optional) Examples: • Artificial Intelligence Focus • Big Data Focus • Audio Experiential • Accessible/ Differently abled Focus • Hardware Integrations (ie. Amiibo) • Social Enterprise Focus, MMORPG • B2B Product • Casino product • Adults-only 0/250 Max characters Does your project have any innovative or experiential elements? (optional) Do not provide confidential information here, you can describe a general nature of the type of innovation 0/250 Max characters Do you currently have: (optional) a) Legal counsel b) Accounting counsel c) Financial Advisors d) SRED Credit consultants e) Publishing Agreements f) Other advisors/consultants Additional Info What services are you initially looking for from FMA? (optional) 0/250 Max characters How did you hear about the Full Motion Accelerator? (You may choose more than one) Canada Media Fund or Government Agency Interactive Ontario Entrepreneur or Venture Clinic Bank/Lender/Financier UDX Interactive Rep Element Law Insert Coin Other Gender (optional) Male Female Non-binary Transgender Male Transgender Female Prefer not to answer Prefer to self-describe: Consent I agree to the Terms and Conditions Send Save draft
