211 Warren Street l Newark, NJ 07103 l 973.353.0611 l www.ifelnj.org
Preliminary Information Form
Use this form to let us know how we can help you
take your business to the next level!
Business Name
Contact Name
Title
Address
City, State Zip
Phone
Fax
Email
Website
1.  Current stage of development: select one
2.  Type of ownership:  select one
3. State in which your Company
is legally organized:
4. Business formation year
5.  Describe the principal product/service offered by your company
and the target market that you serve.
6. Do  you have a written business plan?
7. Select the program/service(s) of interest to you:
Press the Ctrl key to select more than one
7a. How much financing do you seek?
(For business plan, financial model and pitch presentation development only)
7b. What are the types of funding sources that you intend to use?
(For business plan, financial model and pitch presentation development only)
Press the Ctrl key to select more than one.
8.  Ownership interest:  Fill in the ownership percentage for all that apply.
%
 %
Black
 Male
Hispanic
 Female
Native American
Veteran
Asian-Pacific
Asian-Indian
 Disabilty
Portuguese
Spanish
Non-minority
Other
9.  Certifications:  Press the Ctrl key to select more than one.
10.  Professional services needs:
Do you have an accountant?
Do you have an attorney?
11.  What are your primary reasons for your interest in IFEL
programs/services?
13.  How did you learn about IFEL?
14.  Please list and describe other programs/resources that you
have utilized to support your business growth?
15.  Comments
The Institute for Entrepreneurial Leadership