Application

BUSINESS INITIATIVE$ Application – SHORT FORM

Print this form, complete it and send it to Business Initiative$ at
360 Farmington Avenue, Hartford, CT 06105

(Confidential)

Personal and Business Information

1. Name: 2. Address:

3. Telephone #:

4. Date of Birth:

5. Where are you right now in the self-employment process? Check all that apply.

a) I’m still trying to decide whether to start my own business. _____

b) I’m in the process of starting my own business. _____

c) I have been selling my product or service for less than 6 months. _____

Date Started: Month/Year_____________

d) I have been selling my product or service for 6 months or more. _____

Date Started: Month/Year_____________

e) I owned a business that was different than current business. _____

6. What is your business or business idea? Please describe.

7. How long have you been thinking about this business?

8. What is your primary motivation for wanting to own your own business?

9. If you are CURRENTLY selling your product or service:

Do you run this business out of your home? Yes ____ No ____

Does your business currently provide: Most/all of your individual income _____

Extra individual income _______

10. How did you hear about Business Initiative$?