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Application form for Women Start 3 (it can be completed in English or in French)
Order Number
Company name
*
Company alternate brand name
*
Names of the company founders
*
Immatriculation Country of the company founders
*
In which country do you market your product
*
Your company is listed on the stock exchange?
*
Yes
No
Do your company have a link with the gouvernement ?
*
Yes
No
Company's phone number
*
Name of the CEO
*
Email of the CEO
*
CEO's phone number
*
Head office adress
*
Location of company registration ( Country )
*
Regions ( Mandatory if based in france )
*
Year the company was founded
*
Legal Status of the company ( Example in French: SARL / SAS ... )
*
What are your company's numbers of registration / VAT ? ( N°d'immatriculation et de TVA )
*
Team size ( Founders + Full time employees )
*
Website
Which category is close to your start-up's activity ?
*
Customer Experience
Operational efficiency
Digital Enterprise and collaborative tools
Artificial intelligence
Tech for Good
Social Impact
Diversity and inclusion
Other
If other, please indicate the category
Please describe your product / service ( 1000 characters max )
*
How is your solution innovative ?
*
What problem does your product / service adress ?
*
What is the stage of development of your product / service ?
*
Prototype
Concept
Commercialized
Industrialized
What is your customer target ? ( add examples )
*
Do you have clients ?
*
Yes
No
If yes, since when ?
*
Who are your competitors ?
*
Why are you interested in working with Orange ?
*
What is your business model ?
*
Have you ever raised funds ?
*
Yes
No
Names of the capital contributors
*
What is your total turnover for the year 2019 ? (sales revenue)
If there is a majority shareholder, name of the ultimate owner (who is the legal or natural person who directly or indirectly owns, controls or exercises ultimate control over this shareholder)
*
If you haven't raised funds are you looking to raise some ?
*
Yes
No
Download your presentation ( 10MO max)
Video of your start-up or solution
Is any person of your company ( Staff, management, shareholder, ... ) involved in the current operation, an employee or a former employee of the Orange Group companies?
*
Yes
No
If yes, please provide name and function
*
Is there a person involved in the start-up who can be possibly in a situation of conflict of interest individually or as a member of a group with Orange ?
*
Yes
No
If yes, please provide name and function and the reason why
*
How did you hear about Orange Fab France ?
*
Do you accept to receive information related to Orange news ?
*
Yes
No
Do you process personal data of a sensitive nature (medical, political, religious...) ?
*
Yes
No
If yes, do you have a DPO (Data Protection Officer) ?
*
Yes
No
And if so, on which platform do you store its data (OVH, AWS, Azure...) ?
*
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First name
Last name
Mail adress
Agreement
*
I accept the use of my personal data in order to process my request submitted via this form.
I have read and I understand
the Data Privacy Notice.
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