Utah 100 Program – 2017 Official “Emerging Elite” Application Form

Deadline: Must be submitted online at www.mwcn.org by June 30, 2017

The Emerging Elite are Utah businesses with great prospects for future growth and success, but which did not otherwise qualify for consideration in the Utah 100 fastest growing company category. To be eligible, the applicant must complete all applicable information below and meet each of the following criteria:

  1. be a for-profit Utah-based corporation, limited liability company, or partnership;
  2. have a minimum of two years of operating history; and
  3. have had a minimum of $50K in total revenues in fiscal 2016.

Note: If the Company had more than $50K in revenue in 2012, please use the Standard application.

CEO Name*
CEO Email*
CEO Executive Admin Name*
CEO Executive Admin Email*
Company Name*
Website*
Business Address*
City*
State*
Zip Code*
Phone*
President, CEO or highest Executive Officer*
Official Title*
CFO Name*
CFO_Email
Marketing or Contact Person Name*
Marketing or Contact Person Company (if different from company applying)*
Marketing or Contact Person Email*
Has your company ever been recognized?*
How many times?*
How Did You Hear About the Emerging Elite?
Describe your company: (50 words or less)*
Fiscal 2012 Total Revenues: (in dollars, no cents, no commas)*
2012 Employee Count (as of Dec. 31)*
2012 Investment Capital Raised (equity and/or debt)*
Fiscal 2013 Total Revenues: (in dollars, no cents, no commas)
2013 Employee Count (as of Dec. 31)*
2013 Investment Capital Raised (equity and/or debt)*
Fiscal 2014 Total Revenues: (in dollars, no cents, no commas)*
2014 Employee Count (as of Dec. 31)*
2014 Investment Capital Raised (equity and/or debt)*
Fiscal 2015 Total Revenues: (in dollars, no cents, no commas)*
2015 Employee Count (as of Dec. 31)*
2015 Investment Capital Raised (equity and/or debt)*
Fiscal 2016 Total Revenues: (in dollars, no cents, no commas)*
2016 Employee Count (as of Dec. 31)*
2016 Investment Capital Raised (equity and/or debt)*
You are welcome to submit no more than five press releases, news reports, or sets of marketing materials or other information you feel is appropriate. Please email them in electronic format to cheri@mwcn.org
By clicking submit the applicant acknowledges and agrees as follows: The information contained in this Application Form is deemed confidential and will not be used other than for purposes of the 2016 Utah 100 Program. The financial information provided herein is accurate and fairly represents the total revenues of the applicant for the fiscal years indicated. If determined to be a 2016 Utah 100 award recipient, (1) the applicant authorizes the use and publication (including media coverage) of the applicant’s name, logo, address, and description without any compensation, (2) the applicant will not (A) in any manner state or imply that MWCN or its sponsors endorse the applicant or its products or services, or that MWCN or its sponsors and agents have reviewed, audited, read, approved, accepted or endorsed the accuracy or completeness of the applicant’s current or past financial statements or information; or (B) use the names MountainWest Capital Network or Utah 100 or refer to any award by the MWCN in connection with any offer to sell or purchase or any sale or purchase of securities, and (3) the applicant agrees to be bound by the Utah 100 Logo and HyperLink License Agreement, available at www.mwcn.org, as the same may be modified from time to time. The applicant recognizes the non-profit, public service nature of the Utah 100 Program and agrees to release and hold harmless the MountainWest Capital Network, the sponsors of the Utah 100 Program, and their respective officers, directors, employees, and agents from any liability associated with or arising out of the Utah 100 Program.