TENANT APPLICATON
I. General
Information
Business Name:
_________________________________________________________
Date Formed:
_____________________Taxpayer I.D. #: ________________________
Current Business
Address:
Telephone: (H)
________________ (W) ________________ (Cell) ________________
E-mail:
____________________________ Website: ____________________________
Current Business
License? ____ Yes ____
No
If yes, locality:
__________________________________________________________
Business Structure: ___ Individual/ Sole
Proprietor ___
Corporation
___ LLC ___
Sub S Corp. ___
Non-Profit Org. ___
Partnership
Principal Business Owner(s) (Use additional pages if required)
Name: ____________________________
Phone: _____________ Ownership %: ____
Address:
______________________________________________________________
City/State/Zip:
__________________________________________________________
Name:
____________________________ Phone: _____________ Ownership %: ____
Address:
______________________________________________________________
City/State/Zip:
__________________________________________________________
Name:
____________________________ Phone: _____________ Ownership %: ____
Address:
______________________________________________________________
City/State/Zip:
__________________________________________________________
Is
business currently in operation?
____
Yes If
yes, year business founded: ____________
____
No If
no, where are you employed? _________________________________
Do
you have a business plan?
____ Yes If
yes, please attach business plan
____ No* If
no, when do you plan to have one completed? ____/____
*Note: No application is complete without a business plan.
Do
you have general liability insurance coverage?
____
Yes If
yes, name of company:
____
No
II. 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(s) are the majority of your customers located?
Who
are your competitors? (Name
at least two)
Why
do you think you have a competitive advantage?
How
do you (or plan to) market and distribute your product or service?
____
Direct Mail ____
Personal Contacts Made by Owner
____
Sales Force ____
Publication Advertising
Describe your experience that relates to your
product/service and the length of that experience (attach resume if available):
List the names and titles of any other officers or key
personnel (attach resumes if available):
IV. Business
Service Needs
Telecommunication needs:
How many phone
lines? ______
How many internet
access connections? ______
What
types of support services are you interested in?
____ Receptionist ____ Secretarial
/Word Processing
____
Copier ____
Fax Machine
____
Mail Handling ____
Conference Room
____
Computer ____
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?
All tenants will be assigned a three-member advisory board of
local business professionals. What areas of expertise would you be interested
in having represented on your advisory board?
V. Facility
Requirements
Are you currently occupying a
facility (either in your home or at a commercial location)?
____
Yes ____
No
If
yes, what is the current square footage?
Office: ______
Sq.Ft. Manufacturing: ______
Sq.Ft.
What
is the approximate monthly cost for this facility?
Rent: $__________ Utilities: $__________
How
many square feet of space does your business require?
Office:
______ Sq.Ft. Manufacturing: ______
Sq.Ft.
If you require manufacturing space, describe machinery and
equipment to be located on the premises and what service support is needed to
maintain this equipment (i.e., electric load, venting and cooling).
If
accepted as a tenant, when would you want to start occupancy in the facility?
____/____
How
many employees will be occupying the space?
Current 1
Year 2
Years
Full-time ______ ______ ______
Part-time ______ ______ ______
Total
number of employees employed by your business: ______
VI. Other
How
did you learn about the Franklin Business Incubator?
How do you think your participation
in the Incubator will benefit your business?
VII. Business
Financial Information
Initial
Capitalization: (Check One)
____ Less than
$10,000 ____
$50,001 to $100,000
____ $10,001 to
$25,000 ____
$100,001 to $500,000
____ $25,001 to
$50,000 ____
Over $500,000
What
are your projections for total gross sales volume?
Year
1: $__________ Year 2: $__________ Year 3: $__________
What
is the amount and source of financing for operating your business?
____ Existing
Loan(s) Amount: $__________
____ Cash/Equity Amount:
$__________
____ Other Amount:
$__________
____ Operating
Expenses are/will be covered by sales
Are you currently seeking additional
funding for your business?
____ Yes ____
No
If yes, please
state amount of funds needed: $__________
Where do
you plan to obtain these funds? ____________________________________
Please list your personal or business’s bank
information as follows:
Bank Name/Branch Phone
# Account
# Representative’s
Name
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
VIII. References
Please
provide three (3) professional references as follows:
Person’s
Name Address/City/State Phone
#
E-mail
I, the undersigned, am applying for
admission to the Franklin Business Incubator. I understand that the information
contained in this application will be held in the strictest of confidence. I
understand that, as a part of the screening process, my credit history and
financial references may be investigated. By signing this document, I give
authorization to the Small Business Development Manager to do so. I understand
that this application is subject to review in all areas and in no way
guarantees my admittance to this program and that no liability will be assumed
by the Franklin Business Incubator.
Signature: Date:
Revised 1/14/09