Application Form

Step Two

Please continue to fill out this application form, so we could submit your application.

Company Name

Company's Website URL

Company's Linkedin URL

CEO Linkedin Link

Date of Company’s Incorporation

Company Size

Where is the company based?

Please describe the company in one sentence

Please describe the company in one paragraph

What is the primary vertical of the company?

Main Business Model

Please select the option that best describes your product's current status

What is the current company investment round

Is the company currently raising capital?

How much capital is the company currently raising?

When did you conclude the last fundraising round? (optional)

How much capital has the company raised in total from investors to date? (excluding grants in Dollars)

How much capital has the company raised in total from grants in Dollars to date?

How many months of burn rate does the company have?

If the company is generating revenue, how much in Dollars?

If the company has clients, who are the most notable?

Provide References From Experts Who Can Indorce your Company:

Why do you want to participate in the Program?

Please Attach the Company's Investor Deck in PDF Format:

Please Attach the Company's One-Pager in PDF Format:

Add any additional relevant company links you would like to Include

How did you hear about us?

First Name

Last Name

Tel (Area Code)

Tel

Position

Acceptance1

By submitting this application, I acknowledge that upon selection for the program, I will be required to sign a Terms and Participation Agreement. I consent to receiving any related email materials from the program organizers.

Acceptance2

I acknowledge that approved startups for the scale up program will be required to sign a 1) participation agreement, including providing Arieli Capital LLC and/or its designees ("Arieli") a participation right to invest up to 20% in a startup's current investment round(s) and 2) a Business Development Agreement, which provides a 5% success fee for any sales and/or business development facilitated by Arieli.

Application Form

Step Two

Thank You

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