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Private Company Profiles for Management

This document contains fields for collecting contact information and eligibility details for a company applying to the Inc. 500|5000 list. It requests the company name, primary contact information, CEO details, marketing contact, and requires confirmation that the company meets the eligibility criteria of $100k minimum revenue in 2008, $2M minimum in 2011, operating for profit in the US, and being independently owned. Payment options are also provided, either a $125 application fee or $200 deposit toward the 2012 conference registration.

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Rajat Gupta
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© Attribution Non-Commercial (BY-NC)
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9 views5 pages

Private Company Profiles for Management

This document contains fields for collecting contact information and eligibility details for a company applying to the Inc. 500|5000 list. It requests the company name, primary contact information, CEO details, marketing contact, and requires confirmation that the company meets the eligibility criteria of $100k minimum revenue in 2008, $2M minimum in 2011, operating for profit in the US, and being independently owned. Payment options are also provided, either a $125 application fee or $200 deposit toward the 2012 conference registration.

Uploaded by

Rajat Gupta
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Basic Information:

Company Name (doing business as)* Official Company Name (if different from above)

Your contact information - Application Primary Contact

A S
Primary Contact First Name* Primary Contact Last Name* Primary Contact Job Title* Primary Contact's Department* Primary Contact Email Address* Verify Email Address*
(no spaces or dashes, please) *

As the primary contact for the application, you will be the main point of contact on behalf of the company for all important Inc. 500|5000 notifications, opportunities, requests, etc . Click here for more info.

Primary Contact Phone Extension

P M

E L
* = Required Field

Representing Firm Information

Are you a firm representing a private company? * Yes I am filling out the application on behalf of a client No I am a member of the actual firm thats applying

Click here for instructions on how to apply on b ehalf of one or more private companies

Promo Code
If you have a Promo Code, please enter it here .

Sponsored by:

A S
Did the company generate a minimum of $100,000 in revenue in 2008?* Yes Did the company generate a minimum of $2 million in revenue in 2011?* Yes Was the company generating revenue by March 31, 2008? * Yes Is the company privately held, U.S.-based, operating for profit, and independent (not a subsidiary/division of another company)?* Yes

Inc. 500|5000 Eligibility: Before you proceed, please be sure that you meet the eligibility requirements below for the 2012 list:
If you have any questions about eligibility, please call our team at 212-389-5505 (toll free at 800-248-0308), or email us at Feedback 5000@[Link]
No

P M
Eligibility Contact Information No No No

E L
* = Required Field Sponsored by:

Eligibility

Contact Information

CEO Information:
CEO First Name* CEO Last Name*

A S
CEO Phone number (no spaces or dashes, please) * CEO's Extension CEO's assistant's Email Is the CEO the founder or one of the founders?* Is the CEO interested in Inc. speaking engagements? Yes No Marketing/PR Contact First Name Marketing/PR Contact Last Name Marketing/PR Contact email Marketing/PR Contact Phone number
(no spaces or dashes, please)

CEO email*

Founder

One of the Founders Not a founder

Marketing/PR Contact Information (if different from CEO or Primary Contact):

P M

E L
* = Required Field Sponsored by:

We reach out to marketing/PR contacts with special information on how to promote the company's Inc. 500|5000 ranking, media opportunities or exclusive event invitations.

Extension

A S

P M

E L

Sponsored by:

A S
*

I agree to the Privacy Policy*

I agree to the Official Rules *

I have the authority to apply to the Inc. 500|5000 on behalf of this company*

Payment OptionsPlease select one of the following payment options:


Pay the $125 Application fee

Save the $125 application fee by putting a $200 deposit toward your 2012 Inc. 500|5000 conference registration. The conference will be held at the JW Marriott, Phoenix, AZ, October 3-5. [Why is this option better?]

P M

E L
* = Required Field

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