Space Inquiry Form - Broad Hollow Bioscience Park

Broad Hollow Bioscience Park - Pushing the Boundaries in Bioscience

Pushing the Boundaries in Bioscience

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Space Inquiry Form

Space Inquiry Form

Broad Hollow Bioscience Park

Space Inquiry Form

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Contact Information - Step 1 of 3

Name *

Title

Company Name / Institution

Company Website

Current Address:

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Fax Number

Email *

Confirm Email

Description of Research and Development Focus *

Stage of Development *

Patents Issued? *

Patent Filings:

Enter URL OR Upload File (Max Size 10MB)

Enter URL

Upload File (Max Size 10MB)

Click or drag a file to this area to upload.

Only the following file types are allowed: .pdf, .doc, .docx, .ppt, .pptx, .potx, .rtf, .xlsx, .xlsm, .xlsb, .xltx, .xltm, .xls, .txt, .jpg, .png, .jpeg

Funding in Place? *

Funding Sources: *

Next Planned Funding Round Date *

Funding Amount *

Business Plan in Place? *

Please Upload Your Business Plan Here (Max Size 10MB): *

Click or drag a file to this area to upload.

Please Upload a One-Page Business Summary Here (Max Size 10 MB): *

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Funding and if

Estimated Wet Lab Space Needed in sq. ft. (Enter ‘0’ if not needed) *

Estimated Office Space Needed in sq. ft. (Enter ‘0’ if not needed) *

Number of Employees (Including Founders) *

Expected Hires:

Year 1

Year 2

Year 3

Additional Comments / Information:

Custom Captcha *

What is 7+4?

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3 Bioscience Park Dr
Farmingdale State College
Farmingdale, NY 11735-1021
631-227-3940

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8:30 AM – 4:30 PM

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