Personal Information
Name
Company
Address
City
State
Zip
Telephone
Fax
E-mail
Website
Business Information 1. Are you currently in business?    Yes    No 2. Have you sold your product or service yet?   Yes    No 3. Business Start Date:       If unsure, please list approximate date. 4. Legal Entity:   Sole Proprietorship   Partnership   Corporation                        S Corporation    LLC 5. Number of Employees:      Full time         Part time 6. Percent Female Ownership:    (0-100%) 7. How have you financed your business? Please check all that apply.     Personal Savings      Bank Loans        Economic Development Loans     Family Loans           Seller Loan       Credit Cards     Home Equity Loan   Outside Investors 8. Please type any questions or comments below.
Please only submit once. Home