Skip to form
Company name
*
Email
*
(This will be used for all communications.)
City
*
State (HubSpot)
*
Postal Code
EIN
*
DUNS Number
*
Brief Description of the Business
*
Business Type
*
Sole Proprietorship
Partnership
Limited Liability Company (LLC)
C-Corporation
S-Corp
Nonprofit
Limited Cooperative Association (LCA)
Other
Not applicable
Unregistered Business
B-Corp
Number of Years in Operation
*
Number of Full-Time Employees
*
Number of Part-Time Employees
*
Management Information
*
Please list any individual and/or entity with 20% or more ownership interest and the percentage of ownership. (E.g., Jane Smith - 100%. John Smith - 51%, Michael Jones 49%. Charlie Doe - 60%, Avery Smith - 20%, FictitiousVenturePartner, LLC - 20%)
First name
*
Last name
*
Street address
*
Gender
*
Please Select
Male
Female
Non-Binary
Other
Transgender
Military Status
Please Select
Military Spouse
Active Duty
Military Reserve/National Guard
Veteran
Service Disabled Veteran
Never served
Prefer not to say
No Military Affiliation
Certified CBE or MWBDE
*
Yes
No
Narrative Section
*
We are interested in learning more about your business, team, and vision. Please respond to the following questions within the alloted word count. There are several factors considered in the evaluation process. Wacif will undertake a holistic review of the business, its management, financial position and growth plans. Also, we may elect to ask you for an interview. * (Describe your business in 100 words or less)
Leadership Team
*
Who are the founders and key team members? What relevant experience does the leadership and team have? Who manages the day to day operations? (250 words or less)
What do customers love about your business?
(75 words or less)
Financial Position
*
Please provide the profit and loss statements (income statement) for the previous 3 years of 2015, 2016 & 2017. (Please enter the top and bottom line numbers into the field (e.g., 2016: Sales $150,000, Net Profit: $25,001).
Describe your vision for growing your business over the next 6 months, 12 months, 2 years.
(Primary function(s), objectives, goals, revenue, etc.) 300 words or less
Final Question
*
Through a competitive application process, up to fifteen local and independently owned small businesses will be selected for the upcoming Ascend Capital Accelerator cohort. From your perspective, how can the Ascend Capital Accelerator help your business? Why should Wacif consider and select your business for Cohort 4? (No minimum or maximum word requirement)
Outside of the Ascend Capital Accelerator would be interested in receiving small business advisory/technical assistance services from Wacif? (Optional)
These services are of no cost to you
Yes
No
Electronic Signature
*
Please enter your name and title.
Date
*
Year
/
Month
/
Day
Wacif is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. If you consent to us contacting you for this purpose, please tick below to say how you would like us to contact you:
I agree to receive other communications from Wacif.
You can unsubscribe from these communications at any time. For more information on how to unsubscribe, our privacy practices, and how we are committed to protecting and respecting your privacy, please review our Privacy Policy.
By clicking submit below, you consent to allow Wacif to store and process the personal information submitted above to provide you the content requested.
Submit