Enterprise Corps. Business Application

ENTERPRISE CORPS

BUSINESS APPLICATION

By completing this form, I hereby give the Indy Chamber and Business Ownership Initiative permission to contact me about my interest and share submitted information to affiliated parties directly involved in the program

Business Owner 1 Name*

First Name

Last Name

Business Owner 1 Email*

Business Owner 1 Phone*

Business Owner 2 Name (if applicable)

First Name

Last Name

Business Owner 2 Email

Business Owner 2 Phone

Legal Business Name (as registered with the Indiana Secretary of State)*

In a brief paragraph, please describe your business. This should provide a clear explanation of your business, its services and any other meaningful insights.*

Business Address*

Address Line 1

Address Line 2

City

State

ZIP Code

County (business's primary address location)*

Business Email*

Phone*

Business Web Address*

Other Business URL (Facebook, Instagram, Other?)

Business Industry*

Business Start Date/Registration Date*

Full-Time Employee Count (if 0, enter 0)*

Part-Time Employee Count (if 0, enter 0)*

Contractor Count (if 0, enter 0)*

Legal Structure*

Is your business 51% or more owned by any of the following? (Select all that apply):*

Woman-owned Minority-owned Veteran-owned None of the above

Please specify the minority ownership

American Indian/Alaskan Native Asian Black or African American Native Hawaiian or other Pacific Islander More than one race

Is your business owned by an individual who considers themselves a person with a disability? (51% or more) *

Yes No

Is your business certified as an XBE business? (certification is obtained through federal, state or local certification entities) If so, choose the appropriate certification. *

2021 Gross Receipts* $

If loss, enter negative number

2021 Profit/Loss* $

If loss, enter negative number

How much income or salary did you pay yourself in 2021?* $

Has your company experienced revenue growth in the last year?*

Yes No

Indicate the percent growth or decline*

Indicate growth with a plus (+10%) and decline with a minus (-10%)

What services have your received from the Indy Chamber/Business Ownership Initiative (BOI)? (select all that apply)*

I participated in individualized business coaching I recieved a loan I attended a training or event I have not received any services from BOI I would like to learn more about how BOI supports Indy small businesses

Have your received funding from any other source to start or grow your business?*

Yes No

Type of funding received? (select all that apply)

Bank loan Crowdfunding Grant Individual Development Account funds (IDA) Investment capital Line of Credit Other

If other, please describe:

What business growth opportunities exist/would you like to explore?*

What personal growth opportunities would you like to explore? *

Identify any historical or potential future barriers to business growth?*

Identify any historical or potential future barriers to personal growth?*

If "Other", please describe the assistance you are seeking.

Please upload a copy of your 2021 Profit and Loss Statement. Ensure the business name is in the document title before uploading.

No File Chosen

File uploads may not work on some mobile devices.

Please upload a copy of your 2021 Balance Sheet. Ensure the business name is in the document title before uploading.

No File Chosen

File uploads may not work on some mobile devices.

Please upload a copy of your business plan (if you have one and it is reasonably current)

No File Chosen

File uploads may not work on some mobile devices.