Growth Acceleration Service Application

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Full Name:
Title:
Company Name:

Mailing Address

Street
Suite/Apt.
City
State
Zip
County

Business Information

Street
Suite/Apt.
City
State
Zip
County

Email Address:
Daytime Phone:
Website Address:
Business Start Date (mm/dd/yy):

Currently In Business: YesNo

Home-Based: YesNo

Business Type: RetailConstructionServiceManufacturingWholesaleOther

Business Description:

Business NAICS Codes (provide all that apply):

Gender: MaleFemale

Race: WhiteBlackHawaiian or Pacific IslanderAsianNative AmericanOther

Legal Structure: Sole ProprietorS-CorpPartnershipLLCCorporationUndecided

Hispanic: YesNo

Current # Employees:
Full
Part
1099

Veteran Status: Non-VeteranGulf War VeteranVeteranVietnam Era VeteranDisabled VeteranService-Connected Disability

Business Owner: Disabled or Handicapped? YesNo

Are you any of the following (Check all that apply)?
SBA BorrowerSBA ApplicantMBE Certified8(a) CertifiedSurety BondedImport/ExportHubZoneCOC

Financial Information

Total Revenues/Sales:
2014: $
2015: $
2016: $

2017 Projection: $
2018 Projection: $

2016 Total Assets: $
2016 Total Net Worth: $

Annual Profit (Loss): $ ProfitLoss

Do you currently have a positive cash flow? YesNo

How often do you receive financial reports (Income Statement & Balance Sheet)?

Is your accounting set-up on Accrual or Cash basis? AccrualCash

Total # EOY Employees:
2014:
2015:
2016:

Additional Comments:

Business Details

What are your main products and services?

Who are your largest customers?

Who are your major competitors?

How do you currently market your products/services?

What is your greatest challenge?

How do you hope to benefit from this service?

Do you have a business plan? YesNo
If yes what Date? (mm/dd/yy):

Do you have a strategic plan? YesNo
If yes what Date? (mm/dd/yy):

Do you have a budget? YesNo
If you have a budget, how often are variance reports reviewed?:

How did you learn about the service?

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