SOLUTIONS - The Entrepreneur Center @ NVTC

ENTREPRENEUR SOLUTIONS APPLICATION :

To Download and Fax this Application Click Here

Company Name:

Main Contact Name:

Title:

Address:

City/State/Zip:

Phone:

Fax:

E-mail:

Web site:

Number of Employees:

Current Annual Revenue:

Date Incorporated:

Type of Business:

Does your company operate as: (Please check one or more that are applicable.)
Business to Consumer
Business to Business
Business to Government
Business to Nonprofit
Not yet determined
Other, please specify

What are your specific goals/main issues that you want to achieve and address through the Entrepreneur Solutions Program? (for this and later questions please use an attachment if you need more space)

Who are your 3 main competiors? (include company names and websites)
1.
2.
3.

Which of the following services do you already have in place with your business?
Please check all that apply.

ATTORNEY

Intellectual Property
Corporate Law
Government Contracts
Securities
Tax
Other (describe)

FINANCING

Commercial Banker
Venture Capitalist
Investment Banker
Other (describe)

ACCOUNTANT

Tax Specialization
Financial Accountant
Other (describe)

MARKETING

Product-related
Service-related
PR/Advertising
Other (describe)

BUSINESS PLANNING

Strategic Planning
Real Estate/Facilities Mgmt
Employee Benefits
Risk Management
Other (describe)

OTHER

Check which members of your management team you have in place:

CEO
COO
CFO
CTO
CMO

VP Sales and Marketing
VP Business Development
Financial Comptroller
Other, please specify

What funding have you received to date if applicable?

Friends and Family:

Angel:

Venture Capital:

Bank Loans:

Other:

$
$
$
$
$

Still looking for funding? If so, how much? $

Do you have any of the following? Please check all that apply and send your plans as an attachment along with this questionnaire.

Executive Summary of Business Plan
Full Business Plan
Financial Model/Projections
Marketing Materials
Other

Have you filed for patent(s)? Yes No

If yes, have these been approved or are you waiting for approval?
Approved
Waiting for approval

Do you have a Board of Advisors? Yes No

If so, please list the names and affiliations of Advisors, whether it is a formal or informal group.

Do you have a Board of Directors? Yes No

If so, please list the names and affiliations of your Board of Directors.

Do you have any customers or contracts? Please describe (customer name, type of customer, value and duration of contract):

Please describe your target markets. If possible describe potential market size and growth rate goals:

Please list business relevant organizations of which you are currently a member:

Attach or type your Bio/CV for key management team members
(xls, doc, pdf)

I hereby agree to these terms and conditions.

There is a $50 charge for companies that are not members of the Northern Virginia Technology Council.
Complete this payment section if you are not a member.

Charge my	$50.00
Card Number:
Exp. Date:
Name on Card:

Bruce Gregoire
Desktop Marketing Solutions

"The session was tremendously worthwhile. My business colleagues are jealous!!"

April Young
Comerica Bank

"I encourage NVTC members to consider participating in the program both as advisors and as clients. The value in both roles is enormous and the combination will make us a stronger council and community."

Barry Yatt
Founder
ArchibasX

The Entrepreneur Center @NVTC has been terrific in advising me of opportunities to present my start up to potential investors.