Application
|
Pioneer Center for Business Opportunity TENANT APPLICATION CONFIDENTIAL Note: Assistance with any portion of this
application is available upon request. 1. GENERAL INFORMATION Name of Applicant ______________________________________________ Current Address ________________________________________________ ______________________________________________________________ Former address (if less than 2 years at current address) ________________ ______________________________________________________________ Telephone (h) ____________________ Telephone (w) _________________ Social Security # ___________________ Federal tax ID # ______________ Business Name _________________________________________________ Contact person (if different) _______________________________________ Type of company ____ Sole proprietorship _____ Corporation ____ LLC ____ Partnership _____ Subchapter S Is the business currently in operation? _____ Yes _____ No Is yes, the year founded _______ If no, where are you employed? __________________________________ Do you currently have a business license? ______ Yes _____ No If so, where? _________________________________________________ Do you have a business plan? ______ Yes _____ No (Note: A business plan is required. Assistance is available upon request.) 2. INFORMATION ON
BUSINESS PRODUCT/SERVICE Briefly describe your product or service: _____________________________ ______________________________________________________________ ______________________________________________________________ Briefly describe the market for your product/service (your target customer): ______________________________________________________________ ______________________________________________________________ In what geographic area are your customers located? __________________ ______________________________________________________________ Who are your competitors? _______________________________________ ______________________________________________________________ What is your competitive advantage? ________________________________ ______________________________________________________________ How do/will you market and distribute your product or service? ____ Direct mail ____ Personal contacts made by owner ____ Sales force ____ Publication ____ Other (explain) ____________________________________________ 3. INFORMATION ON
BUSINESS PRODUCT/SERVICE Describe your past experience that relates to your product/service and the length of that experience (attach résumé) ________________________________ _____________________________________________________________ _____________________________________________________________ List names and titles of any other offices or key personnel (attach résumé if possible) _____________________________________________________ _____________________________________________________________ 4. BUSINESS
SERVICE NEEDS What types of office support services are you interested in? _____ Receptionist _____ Secretarial/word processing ____ Copier _____ Mail handling _____ Conference room ____ Fax machine _____ Internet _____ Other ______________________________ Do you currently have an accountant? _____ Yes _____ No Do you currently have an attorney? ______Yes _____ No Do you need management assistance? ______Yes _____ No If yes, what type? _________________________________________ Do you need marketing assistance? ______ Yes ____ No If yes, what type? _________________________________________ 5. FACILITY
REQUIREMENTS Are you currently occupying a facility (either in your home or at a commercial location)? ______ Yes ______ No If yes, what is your current square footage? Office _____________ sq.ft. Manufacturing ______________sq.ft. What is your approximate monthly cost for this facility? Rent $__________ Utilities $___________ How many square feet of space, please describe the machinery and equipment to be located on the premises and what service support is needed to maintain this equipment (i.e., electrical load, venting, cooling, etc.) _______________ ______________________________________________________________ ______________________________________________________________ Will you require any of these special facility needs? _____ Loading docks _____ High voltage _____ Liquids or chemical waste disposal _____ Other (specify) ___________________________________________ If accepted as a tenant, when will you want to start occupancy in the facility? _____________________________________________________________ How many total employees will be occupying the space? Current 1st year 2nd year Full time _______ ______ ______ Part time (<36 hrs/wk) _______ ______ ______ 6.
OTHER How did you learn about the Pioneer Center for Business Opportunity? ______________________________________________________________ How did you think your participation in the Center will benefit your business? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ 7.
BUSINESS FINANCIAL INFORMATION What are your projections for total gross sales volume? 1st year ______________ 2nd year _____________ 3rd year ________ What is the projected source and amount of financing for operating your business? 1st year 2nd year 3rd year Cash/equity $____________ $___________ $__________ Loan(s) $____________ $___________ $__________ Sales $____________ $___________ $__________ Other $____________ $___________ $__________ Are you currently seeking additional funding for your business? _______ Yes ______ No If yes, please state funds needed: $_______ Where do you plan to obtain these funds? ___________________________ _____________________________________________________________ List your business’s bank references (including branch location and representative name) _______________________________________________________ _____________________________________________________________ Complete
the attached cash flow projection worksheet and return with your application. I hereby apply for admission to the Pioneer Center for Business Opportunity. I understand that the information contained in this application will be held in the strictest confidence. I understand that, as part of the screening process, my credit history and financial references may be investigated. I further understand that this application is subject to review and in no way guarantees my admittance to the Center, and that no liability will be assumed by the Pioneer Center for Business Opportunity or by Mountain Empire Regional Business Incubator, Inc. Signature _______________________________ Date ________________ Return this application to:
Pioneer Center for Business Opportunity
|
||
