NGC Business Services Group

803 West Avenue
Rochester, NY 14611
800.440.8775

free business assessment form

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contact information:

First Name:*

Last Name:*

Title:

Address:		Home Business

City:

State:		Zip Code:

County:

Phone:*

Fax:

Email:*

Have you spoken with a BSG sales associate already?:	Yes No	If yes, who?:

How did you hear about us?:

business information:

Business Name:

New:	Existing:

If existing month/year formed:

Type of business:
service real estate transportation high tech health care agriculture franchise contractor / construction manufacturing wholesale other

Type of legal formation:
sole proprietorship partnership corporation limited liability company 501(c)(3) nonprofit other

Website URL:

Provide a description of current or future products and services:

What is your organization's competitive advantage:

Describe any previous business experience and technical expertise of owner(s)/management team:

Number of employees:

What are the goals of your business?
3 months:
1 year:
3 years:

funding background:

Have you financed a business in the past?	Yes No

Do you have a completed business plan?	Yes No

If No, have you completed any sections?	Yes No

Has your business ever filed for bankruptcy?	Yes No

If Yes, please explain:

funding needs:

Estimate the amount of funding you are seeking?	$

What will the funding be used for?
land building and improvements vehicles and/or equipment working capital payroll inventory other

What type of financing are you seeking?

grants
debt financing
government loans
subsidies
tax abatements/incentives
equity financing
other

Please supply us with any additional information you feel is necessary to assess your business or business idea:

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