AlphaInvestmentBank.com

The information you submit on this registration form, will be listed in alphainvestmentbank.com only to the degree of disclosure you request in the "Listing Options" section of this form. For our terms and conditions refer to the Registration Terms and Conditions & Data Protection and Privacy Policy.

Approved Entrepreneur members can access to our Crown - a Directory of Investors, Venture Capitalists and Angels seeking investment opportunities, and our Castle - a Directory of Banks and Financial Institutions.

When you have completed and submitted this form, we shall review your information and activate your registration upon approval.

NOTE: This is not a solicitation to sell or an offer to buy any security. AlphaInvestmentBank.com is not a registered broker/dealer and may not try to persuade you or anyone to sell or buy securities. The information we are gathering is for market research and qualification purposes only.

A. Company Profile

Do you register as an individual or on behalf of your company?
Individual Corporate Other
Gender (if Individual): Male Female

User Name :
Password :
Confirm Password :
Password Reminder Question :
Answer :
Company Name:
Company Type:
Co. Registration No.
Address1:
Address2:
Postcode :	City :
State :
Country :
Telephone1:	Ext.
Telephone2:	Ext.
Fax1:
Fax2:
Cable
E-mail :
Website :
Positions:
Chairman :
Executive Directors :
General Managers :
Senior Managers :

B. Company Information

Date Incorporated	(dd/mm/yy)
Company Secretary/Lawyer
City
Country
Person to Contact
Title

C. Location

Country:

D. Industry

Please tick at least one of these industries

Advertising	Agriculture	Biotechnology
Banking & Finance	Commercial Services	Chemical
Distribution	Education	Energy
Entertainment	Manufacturing	Foods
Franchise	Telecommunications	Infrastructure
Publishing	Restaurant	Transportation
Medical/Health	Real Estate	Consumer Service
Waste Management	Information Technology	Earth Science
	Other Industry

E. Business Plan

1. Company Description
(In no more than 10 words, describe your company's principal business activity. For example, alphaInvestmentBank.com is a "Web-based, Financial & Investment Exchange ".)

2. Competitive Edge
Describe for us what is it about your product or service that makes it special, unique, and outstanding. Consider your competition and marketability. (Limit to 200 words.)

3. Keywords
Enter up to 10 search keywords related to your company, product, or service that are not part of the above Elevator Pitch.

4. Type of Financing Sought

Debt

Equity

4a. Stage of Development

5. Stage of Business Development
How much work has been done with this project (Limit to 200 words.)

6. Source of Revenue & Marketing Strategy
(Limit to 200 words.)

7. Top Competitors
Your top three competitors. (Limit to 60 words.)

8. Competitive Advantage
Your most important, unique, and defensible competitive advantage. (Limit to 100 words.)

9. Current Customers
Your current customers (Limit to 60 words.)

10. Revenue Table

For 5 years with at least 3 years being future years. Enter as multiples of US$1,000.

	Year1	Year2	Year3	Year4	Year5
Year
Revenue
Overhead
Profit

11. Cash Flow Table

Enter as multiples of US$1,000.

	Year 1	Year 2	Year 3
Shareholders Fund
Venture Capital/Bank Loan
Turnover/Income
Expenditure
Net surplus/shortfall

12. No. of Employees
How many full-time employees are there in your company.

13. Key Personnel
List the 6 most important people affiliated with your company (including company founders, key employees, board members, and advisors).

14. Capital Invested to Date
Money invested in your company to date.

US$

15. Capital to Raise
Venture capital your company is now seeking to raise.

US$

16. Stake Available
The percentage of share your company is offering.

17. Approached for Capital
Whom have you approached thus far for venture capital. (Limit to 60 words.)

18. Any Significant Information
Anything else we should know about your company. (Limit to 60 words.)

F. Referral Information

Who referred you to AlphaInvestmentBank.com?

What is his/her e-mail address?

What is his/her phone number?

What company/firm do they work for?

What city/state are they in?

If you were not referred by person or firm, how did you hear about us?

G. Listing Options

Carefully select one of the three Listings Options below. For Options 2. and 3., you hereby acknowledge and agree to appoint "The Company" (referred to in our Registration Terms and Conditions & Data Protection and Privacy Policy) to act as your Intermediary and Consultant.

AlphaInvestmentBank.com reserves the right to not list a company.

1. List my company with full identity. (AlphaInvestmentBank.com may list my company's full information submitted to AlphaInvestmentBank.com.)

2. List my company without identity and contact information. (Other members will not be able to access information about my company's identity and contact, only information on my business plan.)

3. Do not list my company.
(Other members will not be able to access information about my company.)

H. Membership

Please select a Membership Package.

Annual - US$100

Quarterly - US$30

I. Mode of Payment

	Cheque Bank Certified Cheque or Money Order payable to Digital Hub Sdn. Bhd. at: Unit A105 Kyoto Gardens, Persiaran Bukit Jaya, Bukit Antarabangsa, 68000 Ampang, Selangor, Malaysia
	Bank Transfer (Telegraphic Transfer) Payee: Digital Hub Sdn. Bhd. Banker: RHB Bank Berhad Branch: KLCC Branch, Kuala Lumpur, Malaysia. Multi-Currency Account No. 614138 - 00000438

Please check that you have keyed in the correct data.

By clicking the Submit button, you acknowledge having read our Registration Terms and Conditions & Data Protection and Privacy Policy and that you fully understand and accept the same.