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For Official Use Only Date Received VI ECONOMIC DEVELOPMENT AUTHORITY BUSINESS DEVELOPMENT CENTER (SMALL –MIDSIZED ENTERPRISES INCUBATION PROGRAM APPLICATION) Participant Application The Economic Development Authority (“EDA”) houses a Business Incubator program for start-up or expanding small businesses planning to permanently operate within the United States Virgin Islands. Potential participants must submit an application and a business plan for review to assess their firm’s compatibility with the EDA Business Incubator’s purpose and facilities. The Application will be reviewed by the Small Business Incubator Advisory Committee. All information contained in the application will be kept completely confidential. Confidentiality agreements will be signed upon request of the applicant. The application will be reviewed on the following criteria: The applicant must produce a technology based product or service; manufacturing based product and / or service; business consulting service; financial accounting services; proprietary product and / or service; The potential for growth and knowledge-based job creation; A commitment to the ideals of the VIEDA Small-Midsized Enterprises Incubation Program; The ability to benefit from the resources and services provided by the VIEDA Small-Midsized Enterprises Incubation; Compatibility with other existing tenants; The space available and the space required. The following documents are requested in support of this application and should be attached if available. Please put a check next to those items being submitted with this application. Business Plan Business License Corporation or Trademark Documents Resumes or Bios of Management Team Financial Projections – Income Statement and Balance Sheet and Cash Flow Projection for the next three Years Three Years Federal Tax Returns (Business and/or Personal) List of any outstanding or anticipated litigation for the business and/or the management team.* List of current or required capital equipment Product Literature, Brochures, Pictures General Information Please print or type clearly and neatly. The application must be completed in its entirety before it can be processed. A copy of your social security card and driver’s license must be attached upon submission of this application. Do not send originals. Business Information Type of Business Entity (Check One) ( ) Sole Proprietorship ( ) Partnership ( ) Corporation ( ) Limited Liability Company Business Stage (Check One) ( ) Concept- business plan started, market defined ( ) start-up- business plan completed, developing Product/service ( ) Expanding- business is looking to expand its operations If the business is a partnership, provide names of all general partners. Please include social security numbers and percentage of ownership. If business partner is silent, please identify their specific business affiliation: NAME ADDRESS S.S. Number % of Ownership If the business is a corporation, please provide the date of incorporation and names of Officers. Please include the business E.I.N Number. Please attach a copy of the Board of Directors with their business affiliations: NAME ADDRESS S.S. Number E.I.N.# Please identify key management staff for the company (attach a full resume of each) and their Position/ Title: NAME Position/Title Please provide names of the Accountant for this company: NAME ADDRESS TELEPHONE # EMAIL Please provide names of the Attorney for this company: NAME ADDRESS TELEPHONE # EMAIL Occupancy Information Currently occupying: _______Rent space in commercial facility _______ Space at personal residence What is the type and approximate amount of space required? Please note the minimum space available to incubator tenants is 100 square feet. TYPE AMOUNT Office Light Mfg Other The Business Plan A business plan is required to submit this application. If assistance or services are needed, please contact the University of the Virgin Islands Small Business Development Center (VISBDC) at 340-692-5270. Please provide an executive summary of your business plan. Outline at least the following: products/services offered, marketing niche or market served, market strategy and competition and financial needs: Employment Current Number of Employees: Employment Projection in 2-years: Projected number of employees in the next 12 months (please indicate part-time vs. full-time): Business Growth Projections: How will you propose to finance this start-up business? Personal Finance ( ) Loan ( ) Business Savings ( ) Other ( ) If financing will be through a Loan, how much will you need to borrow from a lending institution $_____________________ Briefly describe capital needs for the near future. If more space is needed, please attach separate sheet of paper to this application: Briefly describe need for additional capital in the next 2-3 years. If more space is needed, please attach separate sheet of paper to this application: Business Incubator participation Will any special facilities / adjustments be needed in the incubator unit (such as unit alterations or special electrical requirements)? If Yes, what types of particulars (or specific) assistance do you expect from the business incubator program? How do you think the VIEDA Small-Midsized Enterprises Incubation Program can assist you in developing your business? What are your particular needs as you see them relating to the services of the Business Incubator Program? Please attach any additional information that will assist the committee to understand and evaluate your firm’s potential for growth and success. IMPORTANT: The VIEDA Small-Midsized Enterprises Incubation Program is being established to nurture young entrepreneurial activities by providing affordable workshops and / or office units and technical or operational support to participating businesses. Clients may remain in the incubator for a maximum of three (3) years and during occupancy are expected to show progress in accordance with an approved business plan. Completion of this form is just one part of the application process; applicants will be also required to make a ten (10) minutes presentation to the review and Advisory Board to support the application. Clients will be required to conduct their operations in a businesslike manner at all times to demonstrate commitment to their goals. The VIEDA Small-Midsized Enterprises Incubation Program will offer its counseling service at no cost to its clients. All decisions concerning client businesses are and shall remain the sole responsibility of their owner(s) /managers. Consequently, apart from those arising from a normal landlord tenant relationship, the VIEDA Small-Midsized Enterprises Incubation Program disclaims all liability and responsibility for the management of clients’ businesses and their business endeavors. Clients are required to submit quarterly financial data, as well as any other information deemed necessary or requested by the management of the Incubator Program. Clients are required to comply with all Virgin Islands and Federal Laws and the Rules and Regulations of the Virgin Islands Economic Development Authority and its subsidiaries. ACKNOWLEDGEMENT I HAVE READ AND FULLY UNDERSTOOD THIS FORM AND THE INFORMATION PROVIDED BY ME IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. SIGNATURE OF APPLICANT DATE SIGNATURE OF APPLICANT DATE When the application is completed, please contact the Virgin Islands Economic Development Authority Business Incubator Program at 340-719-2037 to schedule an appointment for submission of the application along with all supporting documents. PLEASE NOTE: The Virgin Islands Economic Development Authority reserves the right to approve or disapprove any application. Additionally the Virgin Islands Economic Development Authority will not process an incomplete application. 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