1 THE CITY OF ATLANTA WOMEN S ENTREPENEURSHIP INITIATIVE APPLICATION The following application for the Women s Entrepreneurship Initiative must be completed and submitted by the primary business owner, CEO or principal of the woman-owned company. A. Applicant Information Please mail to: The City of Atlanta s Women s Entrepreneurship Initiative c/o Invest Atlanta 133 Peachtree Street, N.E. Atlanta, Georgia *First Name MI *Last Name *Date of birth *Gender *Phone Number Secondary Phone Number * Address Social Media User Name Social Media User Name Social Media User Name Check here if you do not have any social media profiles: *Are you a legal resident of the United States of America? Y or N (please circle one) *Are you a legal resident of the City of Atlanta? Y or N (please circle one) B. Company/ Business Information- General *Legal business name *Check the box that describes the structure of your business: Nonprofit Limited Liability Company Sole Proprietorship General Partnership C Corporation S Corporation Limited Liability Partnership Other Limited Partnership
2 2 *If General Partnership, General Partner(s) owns % *Name of General Partner(s) *If Limited Partnership, Limited Partnership owns % *Name of Limited Partners(s) *If you selected Other, describe your ownership structure. * As necessary, attach detail in Section F. to explain your ownership structure. *Where do you currently operate your business? In my residence: Outside of my residence: *If outside of your residence, describe the location of your business.
3 3 *Specifically describe the costs associated with the current location of your business? ie. how much you pay for rent, utilities, business supplies, etc. *County *Postal Code *Business Phone *Business Address Business Website (if applicable) Social Media User Name *Is your business legally licensed to do business and operate in the City of Atlanta? Note - This does not include the City of Atlanta s neighboring cities, municipalities or counties. Y or N (please circle one) *Is your business licensed to do business and operate in any other state(s) or country(ies)? Y or N (please circle one) *If you answered yes, please provide the other locations where your business is licensed: *Is your business legally licensed to do business and operate in the State of Georgia? Y or N (please circle one) *Please provide the month and year that your business was founded. *Are you the founder of the business? Y or N (please circle one) *If you answered no, describe your role in the business:
4 4 *How many employees, including you, does the business have? Please circle one: 1, 2, 3, 4 or 5 *Do you, on behalf of your business, or your business currently belong to any professional memberships or organizations? Please list them here: C. Company/ Business Information- Finance In this section, you will be asked to provide specific information about the financial details of your business. Please provide any supplemental content as an attachment or enclosure (hard copy) to this application, to further support the information you provide in this section, in the Attachments section F. This may include business plans, financial documents, such as term sheets, etc. *Describe how you funded the start of your business.
5 5 *Did you receive any financing assistance to start your business? Y or N (please circle one) *If yes, briefly describe the nature of the financing assistance, be specific with the origin of the financing (e.g., bank loan, personal loan, sell of a minority interest in your business, etc.), the exact amount received and how you used it in your business: *Are you currently in the process of seeking funding assistance? Y or N (please circle one) * How much are you seeking? Please provide the specific amount in USD: *Describe, in detail, how you intend to use the funding assistance.
6 6 *Provide your annual revenues for the years 2013 and Please attach any supplemental documents to support your application in section F. *Provide your operating profit (or loss) for the years 2013 and Please attach any supplemental documents to support your application in section F.
7 7 *Provide your revenue and operating profit (or loss) projections for Please attach any supplemental documents to support your application in section F. *Specifically, how do you plan to generate revenue for your business in 2015?
8 8 *Has the business you are submitting this application for, ever filed for bankruptcy? Y or N (please circle one) *If yes, explain the nature of the bankruptcy judgment below. *Have any liens or other legal judgments been filed against the business associated with this application? Y or N (please circle one) *If yes, explain the nature of the lien/judgment below.
9 9 D. Company/ Business Information- Identity *Which most accurately describes your product or service s development stage? Please circle one option. - Idea - Early development or market testing - Market entry - Growth - Other *If you answered other, please elaborate further, in the space below: *In your own words, please describe your business. Use this section to describe the aspects of your business you want to highlight. *A minimum of 200 words is required for your application to be considered complete.
10 10 *How would you categorize your business? Please circle one of the industry fields below. If you choose to select other please provide a brief description of your business category in the space provided below: - Agriculture - Commercial/Retail - Construction - Education and Training - Energy/Power Generation - Fashion - Financial Services - Haulage/Logistics - Healthcare - Information and Communication Technologies - Intellectual Property Services - Manufacturing/Industry - Media and Entertainment - Oil & Gas - Telecommunication - Textile - Tourism/Hospitality - Transportation - Waste Management - Nonprofit - Other ( Please Specify) *Describe your particular industry. Specifically, where do you see the future of this industry headed, in terms of growth, supply and demand, and customer demographics?
11 11 *What problem or need does your business address? *What makes your business unique? Please offer a minimum of one specific example.
12 12 *How do you differentiate your business from your competition? Please provide one specific example. *Who is your main competition and why? Please identify at least one other entity, product or service that you consider as competition.
13 13 *How would entry into the Women s Entrepreneurship Initiative benefit your business? Specifically describe 2-3 ways that your business would be impacted by your participation in the initiative.*a minimum of 200 words is required for your application to be considered complete. *Why did you choose to base your business in the City of Atlanta?
14 14 *Why would you consider keeping and growing your business in the City of Atlanta? E. Branding / Business Identity *Describe what actions you have taken to grow your business. Provide a minimum of one specific action you have implemented to increase your business visibility and grow your customer base.
15 15 *Did you allocate funding for your advertising and marketing needs in to your 2013 or 2014 business s budget? Y or N (please circle one) * If yes, provide the specific amount for each year, in USD, and describe how the funding was used. *Have you allocated funding for your advertising and marketing needs in to your 2015 budget? Y or N (please circle one) * If yes, provide the specific amount for each year, in USD, and describe how the funding was used. *Describe your typical or ideal customer. Specifically, who does your product or service target? Tip: consider if your service or product is specific to a certain demographic (i.e., age, sex, marital status, etc.) and include that information in your response.
16 16 *Describe who your customer will be in five years. Will they be the same as they are today or do they evolve with your business? *Describe your short-term business goals. What do you plan to accomplish in the next 12 months? *Describe your long-term business goals. What do you plan to accomplish in the next five years? *What has been your greatest accomplishment with your business thus far?
17 17 *What has been your biggest challenge with your business thus far? Please share any additional information about your business that you would like the selection panel to consider. F. Attachments Please provide any additional supplemental content to support your application. Examples of content you may consider including would be: - Logo and brand design - Business plan - Budget sheets - Profit &Loss sheets - Advertising and marketing copy - Letters of recommendation from existing business customers - Proof of award /honors recognition for the business associated with this application - Membership certifications for the business owner/business associated with this application G. Application Certification *Do you certify that you are a City of Atlanta resident or that your business is located within the City of Atlanta? Y or N (please circle one)
18 18 *The undersigned applicant acknowledges that participation in the Women s Entrepreneurship Initiative Program ( WEI Program ) is contingent upon either being a resident of the City of Atlanta or obtaining a City of Atlanta business license at the time if application submittal. Y or N (please circle one) *The applicant further acknowledges having read all applicable rules governing the WEI Program and acknowledges having read the instructions for completing this application. Y or N (please circle one) *The applicant acknowledges that an invitation to submit an application does not constitute a promise of selection into the WEI Program. Y or N (please circle one) *The applicant certifies that the information in this application is true, correct and authentic. The person executing this document represents that he or she has the authority to bind the applicant and all individuals and entities named herein to this warranty of truthfulness and completeness of this application. Failure to provide true and accurate information will result in your disqualification from the competition. Y or N (please circle one) *The applicant acknowledges that the application and any and all supporting materials as well as correspondence relating to this application become property of the City of Atlanta and Invest Atlanta when received. Any proprietary information contained in the application should be so indicated. However, a general indication that the entire contents, or a major portion, of the application is proprietary will not be honored. Applicant acknowledges that this information may be subject to the Georgia Open Records Act, O.C.G.A et. seq. and other applicable federal, state, or local law. Y or N (please circle one) *Applicant Signature *Date *Applicant Name *Indicates Response Required Please mail to: The City of Atlanta s Women s Entrepreneurship Initiative c/o Invest Atlanta 133 Peachtree Street, N.E. Atlanta, Georgia 30303