RoboIndustry Subscription Form
Complete all mandatory fields (bolded).
General Information About Your Business
Legal Name/Entity:
Business Name/Operating As:
Parent Company:
Address Line 1:
Address Line 2:
Address Line 3:
City/Town:
Country:
Please select a country
United States
Albania
Algeria
American Samoa
Andorra
Angola
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia & Herzegovina
Botswana
Bouvet Island
Brazil
British Antarctica Territory
British Indian Ocean Territory
British West Indies
Brunei
Bulgaria
Burundi
Caledonia
Cambodia
Cameroon
Canada
Canary Islands
Canton And Enderbury Islands
Cape Verdi Islands
Cayman Islands
Central African Republic
Chad
Channel Islands UK
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Republic of
Congo, Democratic Republic of
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Dahomey
Dem. People's Republic of Korea
Dem. Republic of Vietnam
Denmark
Djibouti
Dominica
Dominican Republic
Dronning Muad Land - Antarctica
Ecuador
Egypt
El Salvador
England. UK
Equatorial Guinea
Estonia
Ethiopia
Faeroe Islands
Falkland Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern & Antarctica
French Territory of Afars & Issas
French West Indies
Gabon
Gambia
Gaza
Germany
Ghana
Gibraltar
Georgia
Greece
Greenland
Guadeloupe
Guam
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Heard & McDonald Islands
Holland
Honduras
Hong Kong
Hungary
Iceland
Ifni
India
Indonesia
Iran
Iraq
Iraq-Saudi Arabia Neutral Zone
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Johnston Atoll
Jordan
Kazakhstan
Kenya
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Leeward Islands
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Mariana Islands
Martinique
Mauritania
Mauritius
Melanesia
Mexico
Micronesia
Midway Islands
Moldova
Monaco
Mongolia
Montserrat
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Navassa Island
Nepal
Netherlands
Netherlands Antilles
Neutral Zone
New Hebrides
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Ireland, UK
North Korea
Norway
Oman
Pacific Island
Pakistan
Panama
Papua New Guinea
Paracel Islands
Paraguay
Peru
Philippines
Pitcairn
Poland
Polynesia
Portugal
Portuguese Guinea
Portuguese Timor
Principe & Sao Tome
Puerto Rico
Qatar
Republic of Congo
Republic of Korea
Reunion
Romania
Russia
Rwanda
Ryukyu Islands
Sabah
San Marino
Sao Tome & Principe
Saudi Arabia
Scotland, UK
Senegal
Serbia
Seychelles
Sierra Leone
Sikkim
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliliand
South Africa
South Korea
Spain
Spanish Sahara
Spartly Islands
Sri Lanka
St. Christopher-Nevis-Anguilla
St. Helena
St. Kitts
St. Lucia
St. Pierre & Miquelon
St. Vincent
Sudan
Surinam
Svalbard & Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tanzania
Thailand
Togo
Tonga
Transkei
Trinidad/Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
US Pacific Island
US Virgin Islands
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Wake Island
Wales, UK
West Indies
Western Samoa
Windward Islands
Yemen
Zambia
Zimbabwe
Other
Province/State:
AB
BC
MB
NB
NF
NS
NT
NU
ON
PE
QC
SK
Province
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
State
Other
Postal/Zip Code:
Postal
Zip
Other
Main Telephone Number:
CAN/US
Other
Toll-Free Telephone Number:
CAN/US
Other
Business Detail
Year Business Started:
Number of Employees:
1-10
11-100
101-1,000
1,001-10,000
10,000+
Annual Revenue(3 year average):
$
URL/Website address:
Corporate Status:
Franchise
Joint Venture
Limited Liability Company
Non-profit
Partnership
Private Corporation
Public Corporation
Sole Proprietor
other
Country of Incorporation:
Please select a country
United States
Albania
Algeria
American Samoa
Andorra
Angola
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia & Herzegovina
Botswana
Bouvet Island
Brazil
British Antarctica Territory
British Indian Ocean Territory
British West Indies
Brunei
Bulgaria
Burundi
Caledonia
Cambodia
Cameroon
Canada
Canary Islands
Canton And Enderbury Islands
Cape Verdi Islands
Cayman Islands
Central African Republic
Chad
Channel Islands UK
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Republic of
Congo, Democratic Republic of
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Dahomey
Dem. People's Republic of Korea
Dem. Republic of Vietnam
Denmark
Djibouti
Dominica
Dominican Republic
Dronning Muad Land - Antarctica
Ecuador
Egypt
El Salvador
England. UK
Equatorial Guinea
Estonia
Ethiopia
Faeroe Islands
Falkland Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern & Antarctica
French Territory of Afars & Issas
French West Indies
Gabon
Gambia
Gaza
Germany
Ghana
Gibraltar
Georgia
Greece
Greenland
Guadeloupe
Guam
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Heard & McDonald Islands
Holland
Honduras
Hong Kong
Hungary
Iceland
Ifni
India
Indonesia
Iran
Iraq
Iraq-Saudi Arabia Neutral Zone
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Johnston Atoll
Jordan
Kazakhstan
Kenya
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Leeward Islands
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Mariana Islands
Martinique
Mauritania
Mauritius
Melanesia
Mexico
Micronesia
Midway Islands
Moldova
Monaco
Mongolia
Montserrat
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Navassa Island
Nepal
Netherlands
Netherlands Antilles
Neutral Zone
New Hebrides
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Ireland, UK
North Korea
Norway
Oman
Pacific Island
Pakistan
Panama
Papua New Guinea
Paracel Islands
Paraguay
Peru
Philippines
Pitcairn
Poland
Polynesia
Portugal
Portuguese Guinea
Portuguese Timor
Principe & Sao Tome
Puerto Rico
Qatar
Republic of Congo
Republic of Korea
Reunion
Romania
Russia
Rwanda
Ryukyu Islands
Sabah
San Marino
Sao Tome & Principe
Saudi Arabia
Scotland, UK
Senegal
Serbia
Seychelles
Sierra Leone
Sikkim
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliliand
South Africa
South Korea
Spain
Spanish Sahara
Spartly Islands
Sri Lanka
St. Christopher-Nevis-Anguilla
St. Helena
St. Kitts
St. Lucia
St. Pierre & Miquelon
St. Vincent
Sudan
Surinam
Svalbard & Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tanzania
Thailand
Togo
Tonga
Transkei
Trinidad/Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
US Pacific Island
US Virgin Islands
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Wake Island
Wales, UK
West Indies
Western Samoa
Windward Islands
Yemen
Zambia
Zimbabwe
Other
Province/State of Incorporation:
AB
BC
MB
NB
NF
NS
NT
NU
ON
PE
QC
SK
Canada Province
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
US State
Other
Sector
- (check all that apply)
Development sector
Choose One
Industrial
Service
Other
General Description - A brief description of application (must be less than 350 characters)
Company Contact Information
Prefix:
Mr.
Mrs.
Ms.
Dr.
Rev.
First Name:
Last Name:
Title:
Telephone Number:
CAN/US
Other
Extension:
Fax Number:
CAN/US
Other
Email Address:
UserName
Password
Re-Type Password
Amount Seeking?
$100,000
$250,000
$500,000
$500,000 - 1M
$1 - 3 Million
$3 - 5 Million
$5 - 10 Million
$10 - 20 Million
$20 - 50 Million
Development Stage
Concept
Startup
Prototype
Product Launched
Revenue Stage
Break Even
Profitable
Help/explanation on any field is offered from the Vendor Information Help Guide on the Becoming a Vendor web page. Should additional assistance be required contact
info@robotinvestments.com
All information will be kept strictly confidential.
The person submitting this form (i) declares to be authorized to act on behalf of the business and submit this form on behalf of the business, (ii) certifies that the information provided in this form is current, accurate and complete as of the date of this submission, and (iii) acknowledges that Royal Bank will be relying on this information.