Commercialization Station Application

Your Name

Company

Business Full Address

Email

Phone Number

Is this new business affiliated (as a subsidiarydivision) with an established business? If yes, name of parent business:

Date business was established:

Legal Structure Other:

Please give a short description of your business and highlight your product(s)/service(s)

How many employees do you currently have? (Including yourself, Full Time and Part Time)

Please provide a brief description of your challenges or needs (50 words or less). If you are unsure, say “unsure”.

What are the critical business objectives for the next three (3) months?

In general terms, what are the business goals for year one?

In general terms, what are the business goals for year two?

Other stage

List of officers/directors/advisors:

Number of Employees Projected in (# of years):

Type and square feet of space required (office, manufacturing, dry bench, etc)

Special facility requirements (electrical,ventilation, floor load, etc.):

Target date for relocation into the incubator:

Other assistance:

Internet service needs and possible bandwidth capacity:

Affiliation with college/university (if applicable, state yes/no with affiliation):

What do you hope to achieve by establishing a relationship with this incubator?

How did you hear about the Commercialization Station?

Additional comments:

(304) 902-2332