**TESTING** PCUL Entrepreneurship Assessment
Complete the applicant details for the NLUA entrepreneurship assessment.
Applicant Information
Full Name
First Name
Last Name
Email Address
example@example.com
Cell Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Business Information
If established, business name:
Business Description
What products or services do you offer?
Business Address
Business City
Business Zipcode
Website
Employer Identification Number (EIN)
Unique Entity Identifier (UEI)
What year was your business established?
From where do you operate your business?
Please Select
Home-based
Leased space
Owned space
Co-working space
One or more mobile units
Other
What industry is your business? (NAICS)
Please Select
11
21
22
23
31 - 33
42
44 - 45
48 - 49
51
52
53
54
55
56
61
62
71
72
81
92
What is your business entity type?
Please Select
Limited Liability Corporation (LLC)
S Corporation
Sole Proprietorship
Partnership
Corporation
Other
If Other, please specify:
What stage is your business?
Please Select
Start-up phase (business is still in the planning or early development stage)
Established phase (business formed and operational)
Business Age
Please Select
Legacy 20+
10-20 years
5-10 years
2-5 years
Under 2 years
Legal & Certifications
Do you have a Business Tax Certificate?
Yes
No
Active licenses and certifications with Florida
List certifications / certifying agencies
Are you currently bonded?
Yes
No
Do you have business insurance?
Yes
No
Business Plan & Goals
Do you have a current business plan?
Yes
No
If not, are you interested in developing one?
Yes
No
Goal 1
Goal 2
Goal 3
Finances
Personal credit score range
Please Select
300 to 579
580 to 669
670 to 739
740 to 799
800 to 850
Revenue 3 years ago
Revenue 2 years ago
Revenue last year
Have you ever secured business loans?
Yes
No
Secured other types of financing?
Yes
No
Team
How many full-time employees do you have?
How many part-time employees do you have?
How many contracted team members do you have?
Services & Support
What type of service are you seeking?
Please Select
Accounting/Budgeting
Business Licensing
Business Plan Development
Buying/Selling a Business
Cash Flow Management
Customer Relations
Financing/Capital
Franchising
Government Contracting
Human Resources/Employees
International Trade
Legal Issues
Business Management
Marketing Plan Development
MBE/SBE/DBE/WBE Certification
Social Media
Start-up Assistance
Tax Planning
Leveraging Technology
Interested in doing business with a government agency?
Yes
No
Are you currently involved with a coach?
Yes
No
How are you currently advertising your business?
Please Select
Networking/Word-of-mouth
Social Media
Printed and or electronic media (paid or unpaid)
TV
Radio
Podcast
Billboards
Flyer distribution
Affinity or referral programs
Other
Referral
How did you hear about our program?
Submit
Should be Empty: