New Business Owner Application

"*" indicates required fields

Apply to Become a*

Name*

First Last

Nickname or the Name you would prefer for us to use?

Email*

Phone Number: Home

Phone Number: Cell*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you currently own a business?*

Yes

Company Name

If you do, what is the name and nature of your business? Are you a service or do you make a product? (For example: The name of my business is Fancy Pants. I make diaper covers for babies.)*

Do you have a website for your business? If so, please provide

Are you on Social Media? FB? Instagram? Other? Please List with:

What is your work schedule?

Full-Time

Part-Time

All-the-time

Are you currently working in addition to your business?

Where? What is your job title? Or if you haven’t started your business yet, are you currently working at another job? (This also includes our work-at-home ladies!)

What is your family situation?

Children? Are you a caregiver for your parents or spouse? Other relative(s)?

Are you in business or going into business by yourself or do you have or plan to have a partner(s)?

Why do you want your own business?

Is this your first try as an entrepreneur or have you had previous experiences?

If so, what was that business? Is it the same business or are you going in a different direction?

What do you think has either kept you or held you back from either starting a new business or succeeding with your current business?

What do you think are your strengths that will help you succeed as a small business owner?

Where do you want you and your business to be in the next 5 years? 10 Years?

Can you tell us more about yourself?

Your passions? Things that make you mad? What is your favorite thing to do? Where do you like to go to get centered or refreshed? What makes you YOU?