FSBDC
Florida Small Business Development Center Network
Growth Acceleration Service Application
CONTACT & GENERAL BUSINESS INFORMATION
Rev-4-2014
Full Name: Title:

Company Name:

Mailing Address:
Street
Suite/Apt.
City
State
Zip
County

Business Address:
Street
Suite/Apt.
City
State
Zip
County

Email Address:

Daytime Phone: Fax:

Website Address:

Business Start Date

Currently In Business
Yes    No
Home-Based
Yes    No

Business Type:
(Please Choose 1)

Retail Construction Service
Manufacturing Wholesale Other

Business Description:

Business NAICS Codes
(Provide all that apply):


Gender: Male Female

Race:

White Black Hawaiian or Pacific Islander
Asian Native American Other

Legal Structure:

Sole Proprietor S-Corp Partnership
LLC Corporation Undecided

Hispanic: Yes No

Current # Employees:

FULL
Part
1099

Veteran Status:

Non-Veteran Gulf War Veteran Veteran
Vietnam Era Veteran Disabled Veteran Service-Connected Disablility

Business Owner: Disabled or Handicapped? Yes No

Are you any of the following (Check all that apply)?
SBA Borrower SBA Applicant MBE Certified 8(a) Certified
Surety Bonded Import/Export HubZone COC

FINANCIAL INFORMATION
Total Revenues/Sales:

2011
$
2012
$
2013
$

2014 Projection
$
2015 Projection
$

2013 Total Assets
$
2013 Total Net Worth
$

Annual Profit (Loss):
$
Profit Loss

Do you currently have a positive cash flow?
Yes No

Total # EOY Employees:

2011
2012
2013

Additional Comments:

What are your main products and services?


Who are your biggest customers?


Who are your major competitors?


How do you currently market your products/services?


What is your biggest challenge?


How do you hope to benefit from this service?


Do you have a business plan?

Yes No

if yes what Date?



Do you have a strategic plan?

Yes No

if yes what Date?



Do you have a budget?

Yes No

if you have a budget,
how often are variance reports reviewed?


How did you learn about the service?