Economic Development Center of St. Charles County


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	EDC's 2nd Small Business Incubator

Please read through the Application Process for Prospective Incubator Businesses before filling in the form below.

Application For
The Economic Development Center of
St. Charles County


	Business Incubator Program


First Name:

Last Name:

Email:

Company Name:

Street Address:

	City:

State:

Zip:

The information contained in this application will be held in confidence. It will only be shared with members of the Incubator Advisory Committee

Company Description Plan Preparation Form
(Facts about your business.)

Names

Legal / Corporate:

Doing Business As:

Brand / Trade Name:

Subsidiary Companies:

Legal Form

Legal Form of Business:

State Incorporated (if incorporated):

County in which Business is Licensed:

Owner(s) of Company or Major Shareholders:


	Owner(s) / Partners	Home Address
1.
	Phone #	% Owned


2.


3.


4.

Management / Leadership

Chairman/woman of the Board:

President:

Chief Executive Officer:

Other Key Management Members:

Governing / Advisory Bodies:

Number of Members:

Developmental Stage

Year company was founded & incorporated (if a corp.):

Year product(s) or service(s) introduced:

Progress of current plans:

Past milestones and successes (if applicable):

Other developmental indicators:

Financial Status (please provide all applicable information)

Last Year's Total Sales:

Last Years Pretax Profit:

Amount of Funds Sought:

Basic Use of Funds Sought:

Previous Funding and Major Financial Obligations:

Products and Services

General Product / Service Description:

Number and Type of Product Lines:

Number of Products in each Line:

Patents and Licenses

Patents Held / Pending:

Trademarks Held / Pending:

Licenses Held / Pending:

Space Requirements

Please explain your intended use of space within the incubator:

How much space will you need?


Office unit(s) � Sq. Ft.

Manufacturing � Sq. Ft.
(mfg. bays have heat/air/ceiling exhaust)

Expected Move-In Date:

What type of office equipment, material(s), and/or machinery will be used?

Will you have special building needs such as high voltage electricity, soundproofing, ventilation, water or other?

Will you be using toxic chemicals? If YES, please explain:

Will you be generating industrial waste? If YES, please explain:

Job Creation

Number of employees at start up:
(not including owners or partners)

Number of employees at present:
(not including owners or partners)

Expected number of additional employees at:
(employee growth projections from today�s date)

6 Months:		1 Year:		2 Years:		3 years:

Professional Services / References Information

Please provide three business references and/or vendors, including a contact name, address and phone number for each:

1.

2.

3.

Please list service provider name, address and phone number below:


	Name		Address		Phone

Bank Checking:

Bank Loan:

Accountant:

Attorney:

Does your business or any of its principals have any pending lawsuits?

If YES, please explain:

Have you ever declared bankruptcy?

If YES, please explain:

Have you ever been charged with or arrested for any criminal offense other than a minor motor vehicle violation? Include offenses, which have been dismissed or discharged.

Please answer the following questions:

(For start-up companies)
Why are you starting this business?

(For existing companies)
Why did you start your business?

(For start-up and existing businesses)
Why do you think your business will be successful?

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	Economic Development Center 5988 Mid Rivers Mall Dr. Suite 100, St. Charles, MO 63304 Phone: 636.441.6880, Toll Free: (877) 441-6880, Fax: 636.441.6881 E-mail: info@edcscc.com Advanced Technology Center 118 N. Second Street St. Charles, MO 63301 Phone: 636.410.0300, Fax: 636.940.0408 E-mail: info@edcscc.com

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