SmartZone Service Request

SERVICE REQUEST

1. Contact Information (Objective – establish key business contacts)
	First Name
	Last Name
	Business Name
	Business Address
	City State ZIP
	Phone ( )
	Email

2. Structure of company(Objective – develop corporate structure plan)
	Entrepreneur or Sole Proprietor Partnership Limited Liability Company Corporation formed (enter year below) Doing Business As... (enter year and location below)
	Incorporation year (if applicable)
	DBA (if applicable) (year) (where)

3. Current owner involvement (Objective – develop transition plan)
	Full time Other full time job (enter job type below) Other part time job (enter job type below)
	Other current job

4. Compensated employees (full or part-time) (Objective – develop staffing plan)
	1-2 3-10 11-20 21 or more

5. Sales activity to date (Objective – develop sales and market plans)
	No sales Up to $25,000 sales $25,001- $50,000 sales $50,001- $1M sales More than $1M sales

6. Intellectual property (Objective – establish IP position)
	U.S. utility patent applied for (date - mm.dd.yyyy)
	Provisional patent filed (date - mm.dd.yyyy)
	Issued patent (patent no.)
	International patent protection (type)
	Technology licensee from (licensor)

7. Description of primary product(s) or services(s) (Objective – develop product life cycle and portfolio plan)
	a.
	b.
	c.
	d.
	e.

8. Type of business (Objective – develop market strategy)
	B2B, B2G technical research/development/engineering/services Retail sales or distributor of consumer products or services Business consultant Manufacturer Other (enter type below)


9. Facilities (Objective – develop physical space plan)
	None Home based Existing facilities (enter items below)
	(sq. ft.) (type)

10. Financial Reports Available (Objective – develop financing plan)
	Personal tax returns, bank statements, etc.
	Audited business financial statements

11. Competitors (Objective – develop competitive strategies)
	Existing competitors
	a.
	b.
	c.
	Substitute products/services identified
	a.
	b.
	c.

12. Business partners (Objective – plan for management team)
	Investors (number) (integer amount)
	Named VP’s, managers
	Operational businesses (manufacturing, distribution, etc.)
	Other

13. Business advisors (Objective – develop mentor network)
	Financial consultant
	Attorney
	Business consultants (SBA, SBTDC, etc.)
	Industry contacts/advisors
	Other

14. Projections (Objective – develop business plan)
	Pro forma cash-flow statement available