* Name of Business:

* Principal Contact:

Title or Position:

* Address:

* City:

* State:

* Zip Code:

* Work Phone:

Home Phone:

Cell:

Other:

Fax:

* Email:

Web Site:

* Legal Structure of Business:

Sole Proprietor

Partnership

LLP Corp.

LLC Corp.

Corporation

S Corp.

* Year Established:

* Are you employed full-time by the business:

Yes    No

* Current Number of Employees:

Full time   Part time

* Estimated sales for the current fiscal year

* Estimated sales for the previous fiscal year

* Estimated profit/loss for the current fiscal year

* Estimated profit/loss for the previous fiscal year

* Describe your business:

* What is unique about your business that gives you an advantage over your competition?

* What type of assistance are you seeking?

How did you learn about ShoreBank Enterprise Cleveland?

Comments or questions:

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