Application for Aspiring

Business Advisory Council

Sponsored in part by:

Business
Owner____________________________________________________________________

Business
Name______________________________________________________________

Business
Address_____________________________________________________________

City, State, Zip____________________________________________________________

Phone ( )_________________ Fax ( )_______________ Cell/Pager ( )______________

E-mail Address ________________________

Web Site Address _________________________________

Are you a member of the Jacksonville Regional Chamber of Commerce?

_____Yes _____No
General Questions:
1. Month/Year business began (if applicable) __________
% of business owned one or more women__________
Does applicant actively manage the business? ____Yes ____ No
If yes, does applicant manage the business full-time or part-time? ____Yes ____ No
Number of employees (include applicant if applicable): Full Time______ Part Time______
Date fiscal year ends ____________________
Projected monthly sales or revenue
Last month _______
This month _______
Fiscal year _______

2. Do you have a business plan? Yes ____ No____ (if possible, please send business plan with
application).

3. Briefly describe your goals for the business.

Over the next one year:

Over the next three years:

4. Briefly describe your business’ products or services. Include any business literature with
application.

Please describe any management needs you feel should be addressed immediately within your
business. What keeps you awake at night?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Business Questionnaire
Have you met any of the following criteria?

Determined your business structure … Yes … No

Registered your business with the State of FL’s Business & Regulations … Yes … No
Dept.
Obtained business license … Yes … No
Obtained an EIN from IRS … Yes … No
Opened a business checking account … Yes … No
Obtained a Sales Tax Number (excluding service based companies) … Yes … No
Priced your services to generate revenue … Yes … No
Generated at least $1 in revenue … Yes … No
Set up a recordkeeping system … Yes … No
Spoke with an experienced accountant and/or bookkeeper … Yes … No
Written business processes (i.e. service agreements, contracts, policies & … Yes … No
procedures
Created marketing materials (e.g. business cards, brochure, etc.) … Yes … No
Registered a domain name for your business … Yes … No
Launched a functional website/company email addresses … Yes … No
Secured leased space for business (retail, service manufacturing, etc.) … Yes … No
Posted business operation hours … Yes … No
Hired required staff … Yes … No
Register ownership of a business acquisition … Yes … No
For franchises, completion of terms of the franchise agreement … Yes … No
Secured financing … Yes … No

6. Other Comments: ____________________________________________________________

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________
The information contained in this application is provided for the purpose of informing the BAC
facilitators as part of the JWBC peer-to-peer mentoring programs.

I represent that the information provided is true and complete. I understand this is a six (6) session
course delivered over a three month cycle. The total cost of $195 is for the full six (6) sessions.
No adjustments or refunds will be made if the accepted enrollee does not attend all sessions.

Signature_____________________________________

Date___________________

Please return your completed application, attachments and your enrollment fee to:
Pat Blanchard, Director
Jacksonville Women’s Business Center
3 Independent Drive
Jacksonville, FL 32202
Phone (904)366-6640
Fax (904)366-6604

The Jacksonville Women’s Business Center is a program of the Jacksonville Regional Chamber of Commerce Foundation, a
501(c)(3) organization. Jacksonville Women's Business Center is partially funded by the U.S. Small Business Administration's Office
of Women's Business Ownership (OWBO). SBA's cooperation does not constitute or imply its endorsement of any opinions,
products or services. Reasonable arrangements for person with disabilities will be made if requested at least two weeks in advance.
All SBA programs are extended to the public on a nondiscriminatory basis.