Basic Information Please set aside 2 hours to complete the form below! Please fill out the information requested below. Do not continue filling out this document if you do not wish to move forward with 50 State Start-Up Challenge. Along with filling out this document, you give 50 State Start-Up Challenge permission to speak with you (the business owner) about your business. Unless expressed in written format, no one else (not including a lawyer, accountant, and/or majority owner) from your team will be allowed to communicate with 50 State Start-Up Challenge unless listed on this form. Thanks in advance.Page 1 of 6About YouName*FirstLastContact Phone #*Contact Email address*What is your position in this company?Please selectOwnerProject ManagerBoard MemberLawyerAccountant Public RelationsRepresentative (all others)Do you have a business plan?if you already have a previous version of your business plan, please upload it here for review.if you already have a previous version of your business plan, please upload it here for review.Do you have a business plan online?if you already have a previous version of your business plan, please copy the link here for review.Purpose of Business PlanPlease selectPartnership ProposalInvestment Proposal Financing / Funding Project ProposalFor "In House" UsesMore DetailsDo you have authority to make decisions?Yes, I doNo, I do notDo you have Proformas?if you already have a previous version of your business plan, please upload it here for review.if you already have a previous version of your Proformas, please upload it here for review.Do you have a Proformas online?if you already have a previous version of your Proformas, please copy the link here for review.if required, what dollar amount are you seeking?Please selectunder $100,000$100,001 to $500,000+$500,001 to $1,000,000+$10,000,000+ and up$20,000,000+ and upMore DetailsNextCompany InformationCompany Legal Name*Company Phone Number*Company Email address*Company WebsiteCompany Facebookplease paste the entire link here. For example https://www.facebook.com/companyFBCompany Instagramplease paste the entire link here. For example https://www.instagram.com/companyIGCompany Twitterplease paste the entire link here. For example https://www.twitter.com/companyTWCompany Blogplease paste the entire link here. For example https://www.limitlessideas.com/companyblogCompany Tik Tokplease paste the entire link here. For example https://www.limitlessideas.com/companyblogCompany Physical Address*Company Mailing Address*How many Employees work for your company?Please selectNot Applicable (None)1-2 Employees3-5 Employees6+ EmployeesHow many Vendors do you work with?Please selectNot Applicable (None)1-2 Vendors3-5 Vendors6+ VendorsHow many 1099 Contractors work with your company?Please selectNot Applicable (None)1-2 1099 Contractors3-5 1099 Contractors6+ 1099 ContractorsHow many Trademarks do you own?Please selectNot Applicable (None)1-2 Trademarks3-5 Trademarks6+ TrademarksBackNextCompany HistoryMission StatementList Company MilestonesPast achievements and awardsTop 3 Target Customerswho do you market to?What is your main industry?What industry do you belong to?What Products do you offer?Please list your Products here:Last years Revenue?Please selectRecently StartedUnder $50,000Under $500,000Over $500,001Year to Date Revenue?Please selectRecently StartedUnder $50,000Under $500,000Over $500,001End of Year Revenue Forecast?Please selectRecently StartedUnder $50,000Under $500,000Over $500,001Vision StatementCSR StatementCorporate Social ResponsibilityWho are your direct competitors?Please list your top 3 competitors? What is your secondary industry?What secondary industry do you belong to?What Services do you offer?Please list your services here:Last years net profits?Please selectRecently StartedUnder $50,000Under $500,000Over $500,001Year to Date net profits?Please selectRecently StartedUnder $50,000Under $500,000Over $500,001End of Year net profits?Please selectRecently StartedUnder $50,000Under $500,000Over $500,001BackNextUpload your TIN/EINUpload your EIN / Tax ID PDF (Employer Identification Number)Maximum size 10MB. PDF, DOC, TXT only, pleaseOnline EIN/TIN link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfUpload your State Certificate of Good Standing PDFUpload your State Structure (LLC or INC) PDFMaximum size 10MB. PDF, DOC, TXT only, pleaseOnline State Structure (LLC or INC) PDF link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfUpload your City/County Business License PDF hereUpload your City/County Business LicenseMaximum size 10MB. PDF, DOC, TXT only, pleaseOnline City/County Business License link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfUpload any and all Professional LicencesUpload Professional LicencesMaximum size 10MB. PDF, DOC, TXT only, pleaseOnline Upload any and all Professional Licenses link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfUpload Professional LicencesMaximum size 10MB. PDF, DOC, TXT only, pleaseOnline Upload any and all Professional Licenses link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfUpload Professional LicencesMaximum size 10MB. PDF, DOC, TXT only, pleaseOnline Upload any and all Professional Licenses link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfUpload Professional LicencesMaximum size 10MB. PDF, DOC, TXT only, pleaseOnline Upload any and all Professional Licenses link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfUpload your SBA Licenses hereUpload Small Business Administration (SBA) Licenses HereMaximum size 10MB. PDF, DOC, TXT only, pleaseAny Online Small Business Administration (SBA) Licenses link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfOnline Small Business Administration (SBA) Certifications including 8(A) link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfOnly Online SBA Minority Owned Licenses link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfOnly Online SBA Woman Owned Licenses link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfOnly Online SBA Veteran Owned Licenses link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfUpload your (DOD) C.A.G.E. CODE PDF hereUpload (DOD) C.A.G.E. CODE HereMaximum size 10MB. PDF, DOC, TXT only, pleaseOnline (DOD) C.A.G.E. CODE link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfUpload your (SAM Number/Profile) PDF hereUpload System for Award Management (SAM) hereMaximum size 10MB. PDF, DOC, TXT only, pleaseOnline SAM Number/Profile link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfUpload your DUNS PDF hereUpload DUNS Number hereMaximum size 10MB. PDF, DOC, TXT only, pleaseOnline DUNS Number link Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfUpload documents and links belowPlease list any other important licenses/ permits and/or certificates below and clearly label the document so we know what it is.Doc#1: Label and upload document with the name of document Maximum size 10MB. PDF, DOC, TXT only, pleaseDoc#1: Label document link with the name of permit/license Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfDoc#2: Label and upload document with the name of document Maximum size 10MB. PDF, DOC, TXT only, pleaseDoc#2: Label document link with the name of permit/license Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfDoc#3: Label and upload document with the name of document Maximum size 10MB. PDF, DOC, TXT only, pleaseDoc#3: Label document link with the name of permit/license Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfDoc#4: Label and upload document with the name of document Maximum size 10MB. PDF, DOC, TXT only, pleaseDoc#4: Label document link with the name of permit/license Provide the link here as shown in example EG: https://www.limitlessideas.com/EIN.pdfBackNextIs your company interested in grants?Please selectNoYesHas your company hired/retained a lawyer?Please selectNoYesDo you have corporate insurance?Please selectNoYesDoes your company have business partners?Please selectNoYesDoes your company have donors?Please selectNoYesDo you provide manufacturing?Please selectNoYesDo you over $10,000 or over worth of orders to fill?Please selectNoYesIs your company interested in Debt Services?Please selectNoYesHas your company hired/retained an account?Please selectNoYesDo you have industry required insurance?Please selectNoYesDoes your company have business sponsors?Please selectNoYesDoes your company have a fan base?Please selectNoYesDo you provide distribution?Please selectNoYesDo you any current contracts with clients?Please selectNoYesBackNextHow would you like to be contacted?How would you like to be contacted?Home / officeMobile / cell phoneEmailMobile TelHome TelEmail addressBackSendThis field should be left blank
