Apply - Fab France

Application form for Women Start 3 (it can be completed in English or in French)

Company

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

Do your company have a link with the gouvernement ? *

Yes

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

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

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

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

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

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

Do you process personal data of a sensitive nature (medical, political, religious...) ? *

Yes

If yes, do you have a DPO (Data Protection Officer) ? *

Yes

And if so, on which platform do you store its data (OVH, AWS, Azure...) ? *

Subscribe to our newsletter

Order Number

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. (opens in a new window)

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

Do your company have a link with the gouvernement ? *

Yes

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

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

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

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

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

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

Do you process personal data of a sensitive nature (medical, political, religious...) ? *

Yes

If yes, do you have a DPO (Data Protection Officer) ? *

Yes

And if so, on which platform do you store its data (OVH, AWS, Azure...) ? *

Subscribe to the newsletter

Order Number

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. (opens in a new window)