Applicant Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

How did you hear about the Garage Program

Co-founder name(s)

Co-founder address(es)

Please put in order of previously listed co-founders.

Co-founder email(s)

Please put in order of previously listed co-founders.

Co-founder phone number(s)

Please put in order of previously listed co-founders.

Company name

Company address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is your business registered or incorporated in Canada?

Registered

Incorporated

What phone number is the primary contact for the business

Phone number - Must be a founder or co-founder

(###)

###

####

What problem do you solve for an individual, business or industry?

How do you propose to solve that problem

Does your solution, or part of your solution, require industrial design, prototyping, and/or manufacturing?

Yes

How much time can you (and co-founders if applicable) commit to working on your startup each week?

Share with us what you have done (to date) to launch your startup.

What is your business model?