Name of Business

First name of owner(s)

Last name of owner(s)

Phone *

Email *

Business Address

Website

Year business was established

Preferred race/ethnicity of owner applying

Are you a veteran owned business?

Number of full-time Employees. (please list number of part time employees separately if applicable*)

Describe your management team with titles and names, have you identified 2-3 key leaders for your exit?

What products/services does your business offer?

General Annual Revenue (Range)

Please list estimated annual revenue for last 3 years

Describe your businesses revenue trends: sporadic, declining, stable, increasing.

General net revenue for last year

Describe the net revenue trends: sporadic, declining, stable, increasing.

Outline any significant capital requirements of your business (describe uses and anticipated costs)

Have you completed any exit planning for your business? What are your hopes for applying for this project?

Do you foresee any upcoming changes in your business? This can include expansion, or new products/services offered. (expansion, new products offered?)

How did you hear about this opportunity?

What is your motivation for considering employee ownership? Share your personal and business goals for employee ownership.

Anything else you’d like to share before you submit?

Please submit any documents ( such as a prior feasibility study ) here.