Issuer Registration


Are you interested in raising business capital? Please provide the following information.

Company Information

Company Name

Address

City

State

Zip

Owner's Name

Email

Phone

Type of Company Product

Primary Industry

How long have you been in business?

Which best describes the current stage of your company?

Raise Information

Raise Amount

Already Raised

Raise Security Offering Type
EquityConvertible NoteHybridUndecided

Business Owner(s) investment thus far?

In what state is the offering located?

Do you have commitments for a portion of the Raise?
YesNo

If you have any questions or would like to receive additional information, please call us at (844) 871-3400 or email us at capitalconcierge@breakawayfunding.com.