Entrepreneurial Development Center

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Client Application

General Scoring Criteria

* Denotes required field.

Client Application

Business name (Company)

* Contact name:

Date:

* Business or personal address:

* City:

* Zip:

Please provide at least one of the following so that we can contact you.

Cell Phone:

Personal Phone:

Business Phone:

Email Address:

More About You

Website:

* Referred to EDC by:

* Description of product/service:

Has your product or service been independently validated by target customers?: Yes No

Does it work as promised?: Yes No

Is the price acceptable?: Yes No

Does it provide value that is not available from competitors? Yes No

Target market -- (Who will you sell it to, how many of them are there, and where are they located?):

Patent / patent application, trademark(s): Yes No

Lawyer name:

Date incorporated:

Revenue:

Bank name & contact:

Business plan complete?

Type of corporation / business?

Funding received to date:

Sources of funding:

Applicant background / experience:

Current number of employees:

* Iowa Farm Bureau Member: Yes No

* What type of assistance are you seeking?:

Public / state funding:

Other non-state funding:

Vendor / resource referrals:

Mentoring:

Other:

Company:

Name of Company:

Authorized Representative:

Title:

Information provided on this application is kept confidential. Once the EDC has received your application, we will review it and be in touch for further information and/or to set up an initial client meeting.

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