Application INFORMATION FORM Your name(s)* Company business or product name Business or Product Name (as it would appear for the public)* Website (if applicable - must include http:// in address) Home address* City* Province* British Columbia Alberta Saskatchewan Manitoba Ontario Quebec New Brunswick Nova Scotia Prince Edward Island Newfoundland & Labrador Yukon Northwest Territories Nunavut Postal Code* Primary Phone Personal Phone Number (with area code): Work Phone Home Phone Email* Current Occupation* Online video link (if applicable - YouTube links only) Age* Describe your business idea in one sentence:* What stage is your business at?* Do you have a patent?* Yes No How much money has been invested in your business or idea so far? (Not including 'sweat equity')* How much investment money would you ask for from The Dragons? (Estimate. Amount can change.)* What does your company or product do?* How does your business or product make money? Where does your revenue come from?* Why are you the best person to run/launch this business?* What are your sales so far, if any? If possible, indicate sales/profits in dollar amount, units sold, etc.* Why did you start your business or concept? What inspired the idea?* What risks have you taken for this business or concept? Give an example of the sacrifices you have made.* Why do you need the Dragons? What will you do with the money if they invest in your company?* Upload an image representative of your business or product. Do you have any relationships with the Producer, the Dragons, or anyone associated with the Program? Please refer to section 11 of the Consent and Release terms outlined above for a full description.* Are you currently a member of any arts union or guild? Please refer to section 12 of the Consent and Release terms outlined above for a full description. If "yes", please provide details.* Do you have any outstanding warrants or other legal issues? Please refer to section 13 of the Consent and Release terms outlined above for a full description. If "yes", please provide details.* I AGREE TO THE CONDITIONS SET OUT ABOVE AND THAT ALL THE INFORMATION GIVEN IN THIS FORM MAY BE USED IN THE PROGRAM AT THE PRODUCER'S SOLE DISCRETION. / JE SOUSCRIS AUX CONDITIONS ÉNONCÉES CI-DESSUS E* I Agree I have read, understand, and agree to be bound by all of the terms and conditions of this Application.* *Once you hit ‘Submit’, a message will be automatically sent to your email address confirming that we have received your application. Good luck!