Business Plan Intake Form
Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Name
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Website
*
Legal Structure
*
Sole Prop
LLC
Nonprofit
C Corp
S Corp
Partnership
Other
Other
*
Please elaborate
Owner's Name
*
First Name
Last Name
Partner(s) Name
*
Owner's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Owner's Business Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year Business Started
*
Business Industry/Type
*
Who Do You Serve?
*
What Do You Provide?
*
Why Does It Matter?
*
(Combine Into A 1–2 Sentence Statement.)
What Is Your Mission Statement?
*
What Is Your Long-Term Vision For The Business ?
*
What Products/Services Do You Sell?
*
How Do You Currently Price Them?
*
What Makes Your Business Unique Compared To Competitors?
*
Who Are Your Target Customers?
*
Who Are Your Main Competitors?
*
What Trends Or Opportunities Exist In Your Market?
*
How Do You Currently Attract Customers?
*
Social Media
Ads
Referrals
Etc.
What's Your Sales Process from Lead → Customer?
*
How Many Staff Do You Currently Have?
*
What Are Your Hours Of Operation?
*
Do You Use Any Systems/Software To Run The Business?
*
Current Annual Revenue.
*
(Approximate)
Current Annual Expense.
*
(Approximate)
Current Profit Margin.
*
(If known)
Do You have Financial Statements?
*
Yes
No
If Yes, Upload
*
Browse Files
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Choose a file
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of
Future Revenue Goals.
*
(1 year, 3 years, 5 years)
How Much Funding Are You Requesting?
*
What Will The Funds Be Used For?
*
(List Categories: Payroll, Rent, Equipment, etc.)
Is This Request Tied To A Forgivable Loan Program? If Yes, Provide Details (Program Name, Forgiveness Conditions).
*
What Community Or Economic Impact Will Your Business Make?
*
(Jobs Created, Services Provided, Underseerved Community Benefits, etc.)
Upload Resumes Of Owners/Leadership
*
Browse Files
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Choose a file
Cancel
of
Upload Business Licenses/Permits
*
Browse Files
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of
Upload Past Financials
*
Browse Files
Drag and drop files here
Choose a file
(P&L, Tax Returns, etc.)
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of
Signature
*
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please verify that you are human
*
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