Contact Information

First Name

Last Name

Email

Phone

What is your primary or preferred language?

Company Information

Business Name

Business Address

City

State

Zip

Country

Business Concept

Industry Categorization

How long have you been in business?

Is the business already selling its products or services?

YesNo

How much revenue has your business generated in the last 12 months?

What progress have you made in the last 6 months? (i.e. product development, followers gained, # of customers, revenue, general progress, etc.)

What specific goals do you have for your business over the next 12 months?

How many employees does your business support? Founders are included in this count. Part-time employees can be counted as 0.5

How does your business intend to impact the city of Cleveland over the next 18 months? (i.e. possible headquarters in the city of Cleveland, job creation sales revenue, social impact, environmental sustainability, etc.)

Use Of Funds

Up to a $35,000 maximum loan amount, how much money does your business need?

Please clarify what you would use the money for AND what impact that would have on your business.

For example, "I would purchase equipment and this equipment would allow me to cut my production time by more than half which would give me an extra 8 hours week to focus on marketing & sales. With an extra 8 hours of marketing & sales per week, I estimate that I can conservatively sell to 10 additional customers each month which would be roughly an incremental $1,000 per month in revenue.

What areas of support could JumpStart offer to ensure that you make best use of any funding that you are awarded (i.e. finance, marketing, talent, etc.)?

Roughly, how much outside funding has your business raised in the past? What was the use of those funds? How did the use of those funds impact your business?

Program Agreement

Please feel free to provide any questions/comments you might have about this opportunity.

PLEASE READ BEFORE HITTING THE SUBMIT BUTTON

In order to serve you, JumpStart personnel will need to familiarize themselves with your business and financial status. By agreeing to these terms, you agree to provide JumpStart with the business and financial information necessary to carry out its assessment. JumpStart will treat this information carefully and confidentially, and will share it publicly only when aggregated with other clients (unless you have previously made the information public). As part of JumpStart's normal collaborative work, the organization will share information with its partner organizations only if it believes it will benefit you and your business. Advice and opinions given by JumpStart to you and your company are intended solely for your benefit. JumpStart disclaims and you waive all warranties related to the assistance it provides to you. Neither JumpStart nor its directors, officers or employees shall be liable to you for damages, including, without limitation, loss of profit or business opportunity.