Entrepreneur Assistance Form
Name
*
First Name
Last Name
Personal Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
abattista@southbendelkhart.org
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How did you hear about Startup South Bend - Elkhart?
Please Select
Website
LinkedIn
Local Event
Email
Friends/Family
If applicable, who referred you?
Startup Business Information
Startup Business Name
*
Please Describe Your Business Idea
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Provide Your Social Media Below
Do you have a business plan?
*
Yes
No
Are you willing to travel to access resources?
*
Yes
No
Is English your first language?
Yes
No
Do you need an interpreter?
Yes
No
Background Information
Is your business currently operating?
*
Yes
No
If "Yes", how long has your business been operational?
If "No", when do you anticipate being operational?
What type of assistance are you looking for?
*
Please contribute any additional information about your startup below.
Submit
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