Small Business Development Center Intake Form

Small Business Development Center
Assistance Form

The Business Idea

Describe your idea or invention:

Industry:

Does the idea have any intellectual property (patent, trademark, copyright, trade secret) or other sustainable competitive advantage?

Describe your business development needs:

Select the business topics you are interested in
(hold down control key to select multiple options):

Professional experience related to idea:

Market Information

Who is the customer?

Where is the market?

What is the market size?

What need does your idea address in the market?

Financial Information

How much money has been invested?

Debt:
Equity:

Have you received any grants?

Type:	(1)		(2)
Amount:

How much can you invest in the idea today?

How much capital do you need?

Contact Information

First, Last Name

Mailing Address

City, State ZIP

County

Please select county as resources are cataloged by county.

Home Phone

(123)456-7890

Demographics

Gender

Female
Male

Veteran Status

Ethnicity

Hispanic?

Yes
No

Education