Principal Signer
Information
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Name (First & Last): |
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Street Address:
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City:
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State:
Zip:
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Daytime Telephone:
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(xxx-xxx-xxxx) |
Evening Telephone:
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(xxx-xxx-xxxx) |
Cellular Telephone:
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(xxx-xxx-xxxx) |
Email Address:
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Date of Birth:
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(xx/xx/xx) |
Social Security No.:
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(xxx-xx-xxxx) |
Driver's License No.:
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State:
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Secondary Signer Information (if applicable) |
Name (First & Last): |
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Street Address:
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City:
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State:
Zip:
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Daytime Telephone:
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(xxx-xxx-xxxx) |
Evening Telephone:
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(xxx-xxx-xxxx) |
Cellular Telephone:
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(xxx-xxx-xxxx) |
Email Address:
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Date of Birth:
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(xx/xx/xx) |
Social Security No.:
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(xxx-xx-xxxx) |
Driver's License No.:
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State:
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Business & License Information |
Date Business Formed:
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(xx/xx/xx) |
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Trade Name:
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Trade Name Registration No.: |
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Have you registered with
the IRS for an Employee ID No.?
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Yes
No |
Employee ID No.: |
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City No.:
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County No.:
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State No.:
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If not obtained, please explain:
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Company Information |
Structure:
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Corporation
LLC
Partnership
Sole Proprietorship |
Product:
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Assembly
Export/Import
Manufacturing |
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Service
Technology
Other |
If other, please specify:
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Standard Industry Code (SIC Code)
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Description of your
product or service:
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Your relevant background
and education in field:
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Source of Initial Capital:
Check all that apply. |
Grants
Loans
Public Offerings |
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R&D Funds
Seed Capital
Other |
If other, please specify:
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Is additional funding necessary?
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Yes
No |
Initial Capitalizaton:
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< $10,000
$10,000 - $20,000
> $20,000 |
No. of Employees:
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Part Time
Full Time:
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Do you have a
written business plan?
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Yes
No |
If yes, completion date:
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(xx/xx/xx) |
If no, do you have
a plan in progress?
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Yes
No |
(xx/xx/xx) |
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Services
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On-Site Office Tenant
Virtual Office Tenant
Support Services |
Space Needs |
Total square feet required of each
category: |
Office:
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sq. ft. |
Manufacturing:
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sq. ft. |
Retail:
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sq. ft. |
Research:
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sq.ft. |
Additional requirements:
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If other, please list requirements:
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Date space required
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(xx/xx/xx) |
Resources currently in use or needed for the
future. Please check all that apply. |
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Please provide two business credit references
and one bank reference: |
Credit Reference 1:
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Telephone:
(xxx-xxx-xxxx) |
Credit Reference 2:
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Telephone:
(xxx-xxx-xxxx) |
Bank Reference:
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Telephone:
(xxx-xxx-xxxx) |
The applicant, in submitting
the above information, agrees that the credit information
may be requested from credit reporting agencies.
The applicant agrees that if any information contained
in this application is found to be incorrect and
submitted with the knowledge of this, Kavleys Business & Tech
Center will have grounds for (1) not considering
this application or (2) if a member of Kavleys,
to be grounds for immediate dismissal. |
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