SECTION 1 — Contact Info

First Name *

Last Name *

Phone Number *

Email *

Organization Name *

Website *

Address

Street Address *

City *

State *

Country *

Postal Code *

How did you hear about this opportunity? *

SECTION 2 — Foundation & Revenue Profile

1. How long have you been in business, and what problem do you exist to solve? *

2. Average Transaction Size (Select One): *

3. Primary Revenue Structure (Select One): *

4. Annual Revenue Capacity (not current revenue, but realistic ceiling within current model) (Select One): *

5. What percentage of your revenue is recurring or contractually secured? (Select One): *

6. Which best describes your internal systems? (Select One): *

7. When forced to choose, what defines your company most? (Select up to two): *

8. How do you personally engage with your own product or service? (Select One): *

If not actively using it, briefly explain why: *

9. Do your customers or facilities have a potential need for energy optimization (cost reduction, power quality, EMF mitigation)? (Select One): *

10. At what level would you participate in U-ACT if aligned? (Select one): *

11. If capital and resources were not the constraint, what long-term impact would your business pursue? Short answer (300–400 characters max) *

12. Who in your network should also be considered for CPL representation or U-ACT involvement? Short answer (Name + Company + Role) *