Retail Business Incubator Application

1

Business/Start-Up Name* This field is required.

2

Owner's Name* This field is required.

First Name

Last Name

3

Founding Date* This field is required.When did you create your business?

Date

4

Phone Number* This field is required.

Please enter a valid phone number.

5

Email* This field is required.

example@example.com

6

Signature* This field is required.

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7

Where is your business location? * This field is required.

8

What is the current stage of your company? (Pre-seed, seed, growth, later stage)

Pre-seed

Seed

Pop-Up

E-Commerce

Later Stage

9

What do you need support with the most?* This field is required.

10

How large is your team? (including yourself)* This field is required.

11

Business Tagline* This field is required.Your business in 5 words or slogan. If no tag line, type N/A

12

Do you have a background or experience in your business industry?* This field is required.

13

How did you hear of us?

14

How did you hear of us?* This field is required.

Facebook

Instagram

Park Central Development

Small Business Empowerment Center

Other

15

Are you the license holder of an intellectual property right?* This field is required.

YESNO

16

Do you make less than $200,000 in annual revenue?* This field is required.

YESNO