Wufoo

Investor Survey

This survey serves multiple purposes—first and foremost to learn who our members are and what our companies do so that we can better serve them. PSL intends to gather specific information about each member and their company to create a membership directory. The directory will be distributed within PSL and to the outside investor community.

Participation in the membership directory is OPTIONAL. You can choose to include personal information and withhold company-specific information. You can also opt out completely. No information collected will be made public without your consent.

In order to best serve our growing start up community, PSL is gathering information about our members’ businesses to provide a general picture of our membership to angels, VCs and mentors. Gathering accurate investor information is essential to ensuring an efficient process.

It is our goal to connect startup founders to the investor community in the most effective way possible, but we cannot be successful without more details about your experience and what you can provide to startup leaders. If a field is not applicable to you or you do not have enough accurate information to properly answer a question, we ask that you leave the field blank. Any information gathered will remain confidential and will only be disseminated with your expressed consent.

We sincerely appreciate the efforts of our community to help publicize and grow PSL. Please be aware that PSL has certain criteria for entrepreneurs. Rather than upset our friends and colleagues, please make sure that the person you are referring to PSL fits into our membership guidelines. To learn more about our membership rules, please refer to the membership application.

Member Profile Information
Name * First Last
Email
Phone ### - ### - ####
Phone Extension
Professional Bio
Maximum Allowed: 200 words. Currently Used: 0 words.
Title/Role *
Company Name *
LinkedIn Profile URL
Investor Type *
Are you an accredited investor or an employee of an accredited investor (as defined in Rule 501 of Regulation D of the Federal Securities Laws)? *
Yes No
Demographic Data (private)

The demographic information collected below is intended to assist PSL in securing grants and publicity for the organization and its members. The information will not be made public and will not be included in the membership directory.
Gender *
Year of Birth *
Education *
County where you live *
County where you work *
Company Information

In order to best serve our growing start up community, PSL is gathering information about the investor community to provide to our startup entrepreneurs. Gathering accurate information is essential to the programming we plan to enact. If a field is not applicable to your business or you do not have enough accurate information to properly answer a question, we ask that you leave the field blank rather than give inaccurate information. The specific member or company information gathered will remain confidential and will only be disseminated with your expressed consent.
Company Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Company Web Site
Company Bio
Maximum Allowed: 200 words. Currently Used: 0 words.
Assets Under Management $ Dollars . Cents
Please list the Managing Directors of your firm
Maximum Allowed: 50 words. Currently Used: 0 words.
Stage of Funding
Seed Early Stage Expansion Stage Late Stage
Typical investment amount per company
Geographic Focus
Philadelphia/Delaware Valley Pennsylvania Mid-Atlantic East Coast National International Other
Industry Focus
Apparel/Fashion Biotech/Medical/Health Business Products/Services Chemicals Civic/Social/Non Profit Computer Hardware/Peripherals Consumer Products/Services Defense/Space Education/ E-Learning Electronics Engineering/Construction Environmental Services/Green/Clean-Tech Financial Services Healthcare Services Hospitality Human Resources Internet-Related IT-Services Logistics/Supply Chain Manufacturing Marketing/Advertising Media/Entertainment Medical Devices Networking/Equipment Oil/Energy Packaging Pharmaceuticals Product Development Real Estate Semiconductors Software Telecommunications Transportation Web-enabled Services Wholesale
Membership Directory Options

Please decide if you would like your infomation included in the membership directory. You may include as much or as little information as you wish, and participation is not mandatory.
Would you like your member profile to be included in the membership directory? *
Yes No
Would you like to add your company's information to the membership directory? The information will be made public and will be distrbuted to the startup community. In order to include company information, you must also agree to include your member profile information (question above).
*
Yes No
Do Not Fill This Out