SMARTstart Incubator Program Application

SMARTstart Incubator Program Application
COMPANY INFORMATION
Which location are applying for?:*

Dade CityNew Port RicheyWesley Chapel
Business Name:*
Federal Tax ID or SSN (if sole proprietor)#:*
Upload Sunbiz Division of Corporations filing:

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Business Phone Number:
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Web Address:
example.com
Email:
example@example.com
Type of Business Structure:*
Date Company was established: *
How did you hear about the Incubator?
What type of incubation services are you interested in (please see description of service)?*

REQUIRED STATISTICAL INFORMATION
Business Owned By:*
Minority Owned Business:*

YesNo
Dollar amount of Last Quarter’s Sales:
Dollar amount of Monthly Payroll:
Number of Current Employees:*

BUSINESS RELATIONSHIPS
Commercial Bank (Company name, contact & location):*
Commercial Bank Phone Number:
Please enter a valid phone number.
Legal Representation (Company name, contact & location):
Legal Representation Phone Number:
Please enter a valid phone number.
Accountant (Company name, contact & location):
Accountant Phone Number:
Please enter a valid phone number.
Insurance Provider (Company name, contact & location):
Insurance Provider Phone Number:
Please enter a valid phone number.

PRODUCT/SERVICE INFORMATION:
Describe your products / services and attach any product / service literature: *
Upload product / service literature here:

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Upload Business Plan if available or answer questions in the Business Summary below:

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Is the entity or any of its owners a patent holder?*

YesNo
If yes, please describe:
Does your entity require any special electrical considerations?*

YesNo
If yes, please describe:
Does your entity require any special real estate consideration?*

YesNo
If yes, please describe:

BUSINESS SUMMARY

The following questions are intended to provide a summary of your business. These questions should be answered and submitted to the Pasco Economic Development Council, Inc. as part of the application for acceptance into the SMARTstart program in a separate document in lieu of an official business plan.

Click HERE to provide your answers. The answers should provide enough detail to allow an understanding of your business but be no more than five typewritten pages.
1. WHAT WE DO
  Provide a description of the business, including the range of products and/or services offered. Describe the significant problem that your business addresses.
2. HOW WE DO IT – WHAT MAKES US UNIQUE?
  Describe the key factors that differentiate your business. How will you gain, sustain and grow a market position? How do you gain market share with the market and maintain growth?
3. HOW WE MAKE MONEY
  Describe the revenue model for the business. Provide details of the primary revenue source and mention others if appropriate.
4. WHO ARE OUR CUSTOMERS AND PARTNERS?
  Describe the market, the purchase decision makers in the market, the sales and distribution channel(s), and the sales cycle. Ensure that the information is specific to your business opportunity vs. a generalization of the industry.
5. HOW LARGE IS THE MARKET OPPORTUNITY?
  What is the size of the specific market and how much can you expect to capture annually over the next few years? Provide the source of your research/data.
6. WHAT ARE THE COMPETING SOLUTIONS?
  Describe the alternative products and suppliers that offer your customers a solution. Describe how your solution is superior to the competition.
7. WHEN WE EXPECT TO BE SUCCESSFUL
  Describe the major milestones and challenges for developing the business. Provide a forecast of the number of new employees you will have in your business of the next 2 years.
8. WHO WE ARE
  Describe the principal participants in the business and the positions that need to be filled. What specific strengths and resources does your team bring to the opportunity? What makes you, as individuals, unique?

MEMBERSHIP ELIGIBILITY CRITERIA

Must be registered with the State of Florida (SunBiz) as a Pasco company.
REQUIRED INFORMATION

All documentation must be provided at time of acceptance into the
SMARTstart Incubation Program.
Do you agree to provide a copy of your FL Department of State, Division of Corporations record?*
Do you agree to provide a copy of your Credit Report (must be no more than 6 months old)?*
Do you agree to provide a copy of your Pasco County business tax receipt? (If business tax receipt is not required, member must supply proof from Pasco County that a it is not required.)*
Do you agree to provide a copy of your City business license? (If license is not required, member must supply proof from the City that a license is not required.)*
Do you agree to provide a Certificate of Liability Insurance if required?*
Do you consent to a background check?*

ACKNOWLEDGEMENT & SIGNATURE/S
Name of Entity:*
Authorized Signature
Printed Name:*

First NameLast Name
Please verify that you are human*
Should be Empty: