GNEC Technical Assistance
Business Information
Business Name
DBA
Currently in business?
Yes
No
How much was your initial capital contribution to start the business?
Business Start Date
Does your business engage in exporting goods to other countries?
Yes
No
Is this business pre-startup?
Yes
No
NAICS Code
Business Credit Score
Type of Business
Professional, Scientific & Technical Services
Mining
Manufacturing
Real Estate & Rental & Leasing
Management of Companies & Enterprises
Utilities
Finance & Insurance
Health Care & Social Assistance
Agriculture, Forestry, Fishing & Hunting
Information
Wholesale Trade
Accommodation & Food Services
Administrative & Support
Construction
Public Administration
Arts, Entertainment & Recreation
Waste Management & Remediation Services
Retail Trade
Educational Services
Transportation & Warehousing
Other Services (except Public Administration)
Choose your primary category
x
Do you conduct business online?
Yes
No
Are you a home based business?
Yes
No
Are you 8(a) certified by the Small Business Administration (SBA)?
Yes
No
Full-Time Employees
35 or more hours per week - includes business owner
x
Part-Time Employees
24 or less hours per week - includes business owner
x
For your most recent full business year, what were your:
Gross Revenue
Per Year
x
+ Profits / - Losses
Per Year
x
Amount of your Gross Revenues/Sales related to exporting
Per Year
x
Legal Structure
C-Corp
S-Corp
LLC
LLC Partnership
Sole Proprietorship
Partnership
Independent Contractor
Self Employed
501(c)3 - Non-Profit
501(c)6 - Organization
501(c)19 - Veterans Organization
Housing Cooperative
Tribal Business
Other
Other Legal Structure
Client Information
First Name
Last Name
Email
Primary Phone Number
Birthdate
Address
Mailing Street
Mailing City
Mailing State/Province
Mailing Zip/Postal Code
Mailing County
Race
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Prefer not to answer
Other
Ethnicity
Hispanic
Non-Hispanic
Not Applicable
Other
Prefer not to answer
Other: Race
Other: Ethnicity
Gender
Male
Female
Non-Binary
Prefer Not To Say
Transgender Female
Transgender Male
Gender Varian/Non-Conforming
Not Listed
Do you consider yourself a person with a disability?
Yes
No
Number of Adults in Household
Number of Children in Household
Individual Income
Per Year
x
Household Income
Per Year
x
Consumer Credit Score
Primary Language
Employment Status
Employed full-time in business
Employed part-time in business
Employed full-time outside of business
Employed part-time outside of business
Unemployed
Retired
Displaced Homemaker
Veteran Status
No military, Reserve, or National Guard service
Veteran
Service-Disabled Veteran
Member of the Reserve
Active Duty
Member of the National Guard
Spouse of Military Member
Education Level
Grade School
Junior High School
High School Diploma / GED
Trade School / 2-Year School
4-Year College / University
Graduate School
Current Marital Status
Single
Married
Separated
Divorced
Widowed
Domestic Partnership
Do you receive public assistance?
Yes
No
How much do you receive on a monthly basis?
Were you born outside of the United States?
Yes
No
Do you have refugee or Asylum Status?
Yes
No
Business Needs
What is the nature of counseling you are seeking?
Start-up Assistance (How do I start a small business?)
Business Plan
Financing/Capital (such as applying for a loan, building equity capital)
Managing a Business
Human Resources/Managing Employees
Customer Relations
Business Accounting/Budget
Cash Flow Management
Marketing/Sales (promotion, market research, pricing, etc.)
Government Contracting (including certifications)
Franchising
Buy/Sell Business
Technology/Computers
eCommerce (using the Internet to do business)
Legal Issues (such as, Should I incorporate?)
International Trade
Tax Planning
What type of business are you starting or expanding? Why?
Describe specific assistance requested in the space provided
Referred by?
IFEL
Rising Tide Capital
SBDC
WCEC
NJEDA
NJBAC
NJBOC
GNEC Underwriting Team
Other
Is there a second owner of this business?
Yes
No
Second Owner's Information
First Name
Last Name
Email
Primary Phone Number
Birthdate
Address
Mailing Street
Mailing City
Mailing State/Province
Mailing Zip/Postal Code
Race
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Prefer not to answer
Other
Ethnicity
Hispanic
Non-Hispanic
Not Applicable
Other
Prefer not to answer
Gender
Male
Female
Non-Binary
Prefer Not To Say
Transgender Female
Transgender Male
Gender Varian/Non-Conforming
Not Listed
Do you consider yourself a person with a disability?
Yes
No
Number of Adults in Household
Number of Children in Household
Individual Income
Per Year
x
Household Income
Per Year
x
Consumer Credit Score
Primary Language
Employment Status
Employed full-time in business
Employed part-time in business
Employed full-time outside of business
Employed part-time outside of business
Unemployed
Retired
Displaced Homemaker
Veteran Status
No military, Reserve, or National Guard service
Veteran
Service-Disabled Veteran
Member of the Reserve
Active Duty
Member of the National Guard
Spouse of Military Member
Education Level
Grade School
Junior High School
High School Diploma / GED
Trade School / 2-Year School
4-Year College / University
Graduate School
Current Marital Status
Single
Married
Separated
Divorced
Widowed
Domestic Partnership
Do you receive public assistance?
Yes
No
How much do you receive on a monthly basis?
Were you born outside of the United States?
Yes
No
Do you have refugee or Asylum Status?
Yes
No
Is there a third owner of this business?
Yes
No
Third Owner's Information
First Name
Last Name
Email
Primary Phone Number
Birthdate
Address
Mailing Street
Mailing City
Mailing State/Province
Mailing Zip/Postal Code
Race
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Prefer not to answer
Other
Ethnicity
Hispanic
Non-Hispanic
Not Applicable
Other
Prefer not to answer
Gender
Male
Female
Non-Binary
Prefer Not To Say
Transgender Female
Transgender Male
Gender Varian/Non-Conforming
Not Listed
Do you consider yourself a person with a disability?
Yes
No
Number of Adults in Household
Number of Children in Household
Individual Income
Per Year
x
Household Income
Per Year
x
Consumer Credit Score
Primary Language
Employment Status
Employed full-time in business
Employed part-time in business
Employed full-time outside of business
Employed part-time outside of business
Unemployed
Retired
Displaced Homemaker
Veteran Status
No military, Reserve, or National Guard service
Veteran
Service-Disabled Veteran
Member of the Reserve
Active Duty
Member of the National Guard
Spouse of Military Member
Education Level
Grade School
Junior High School
High School Diploma / GED
Trade School / 2-Year School
4-Year College / University
Graduate School
Current Marital Status
Single
Married
Separated
Divorced
Widowed
Domestic Partnership
Do you receive public assistance?
Yes
No
How much do you receive on a monthly basis?
Were you born outside of the United States?
Yes
No
Do you have refugee or Asylum Status?
Yes
No
Is there a fourth owner of this business?
Yes
No
Fourth Owner's Information
First Name
Last Name
Email
Primary Phone Number
Birthdate
Address
Mailing Street
Mailing City
Mailing State/Province
Mailing Zip/Postal Code
Race
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Prefer not to answer
Other
Ethnicity
Hispanic
Non-Hispanic
Not Applicable
Other
Prefer not to answer
Gender
Male
Female
Non-Binary
Prefer Not To Say
Transgender Female
Transgender Male
Gender Varian/Non-Conforming
Not Listed
Do you consider yourself a person with a disability?
Yes
No
Number of Adults in Household
Number of Children in Household
Individual Income
Per Year
x
Household Income
Per Year
x
Consumer Credit Score
Primary Language
Employment Status
Employed full-time in business
Employed part-time in business
Employed full-time outside of business
Employed part-time outside of business
Unemployed
Retired
Displaced Homemaker
Veteran Status
No military, Reserve, or National Guard service
Veteran
Service-Disabled Veteran
Member of the Reserve
Active Duty
Member of the National Guard
Spouse of Military Member
Education Level
Grade School
Junior High School
High School Diploma / GED
Trade School / 2-Year School
4-Year College / University
Graduate School
Current Marital Status
Single
Married
Separated
Divorced
Widowed
Domestic Partnership
Do you receive public assistance?
Yes
No
How much do you receive on a monthly basis?
Were you born outside of the United States?
Yes
No
Do you have refugee or Asylum Status?
Yes
No
Contact Information