First Name:
Last Name:
Company:
Address 1:
Address 2:
City:
State/Province:
Zip Code:
Country:
Web Site:
Email Address:
Verify Email:
Home Phone:
Business Phone:
United States Company?:
Yes
No
Business Structure Type:
Sole Proprietor
Partnership
Limited Liability Company (LLC)
C-Corporation
S-Corporation
Other
Date Established:
State Established In:
Not yet established
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Number of Employees:
0 to 10
11 to 50
51 to 100
101 to 500
500+
Are You Currently Producing Revenues?:
Yes - Government Grant Only
Yes - Government Contracts Only
Yes - Commercial Activities - Non-Government
Yes - Both Government and Non-Government Revenues
No
Industry:
Customers Are Primarily:
Individuals/Consumers
Corporations/Businesses
Institutional
Government/Government Agencies
Patents:
Yes - Issued
Yes - Pending
Yes - Both Pending and Issued
No
Copyrights/Trademarks:
Yes - Both
Yes - Copyrights Only
Yes - Trademarks Only
No
Government Grant or Contract Recipient?:
Yes - Grants - Phase I's Only
Yes - Grants Phase I and II
Yes - Contracts Only
Yes - Subcontracts Only, No Direct Grants or Contracts
Yes - Grants and Contracts
No
Do You Have Investors?:
Yes - Friends and Family (FFA)
Yes - Accredited and Angel Investors (Angel)
Yes - Venture Capital (VC)
Yes - FFA, Angel, VC, and other
No
How Would You Categorize Your Company?:
Product
Service
Primarily Product with Service Component
Primarily Service with Some "Add-on" Products
e-Commerce
FIT Program:
Business Plans
Enterprise Self-Diagnostics
Financial Strategy and Budgets
Government Grants and Contracts Compliance
On-Shoring - Coming to US
Vision, Strategy, and Structure
What Problem or Issue Are You Trying to Solve?:
Have you ever had a business plan?:
Yes
No
How much time will you devote to this process?:
As much as it takes
No more than 4 hours a week
4 - 10 hours a week
Whatever it takes
What other priorities could get in the way?:
Given the obstacles, how do you plan to get the work done?:
How important is developing a robust busines plan?:
1 - Top Priority
2
3
4
5
6
7
8
9
10 - Not a priority
Comments: