Application for CAN BE Virtual Assistance Click here to download a PDF version of the application. Name * Name of Business Website * Phone * Fax Email * Address Partner(s)/Principal(s) Name 1 Partner(s)/Principal(s) Name 2 Partner(s)/Principal(s) Name 3 Phone Phone Phone % ownership % ownership % ownership Attorney Name Phone Accountant Name Phone Bank Name Phone BUSINESS INFORMATION New Business Existing Business Year Established * Where was the business started? Number of Full-Time Employees Number of Part-Time Employees Legal Structure of Business Sole Proprietorship Partnership Corporation (C, S, or LLC) Please Describe the Business * Ideal Stage Early Stage Prototype Stage (manufactured & sold in small quantities) Developmental Stage (product maturity, sales volume & management capability) Expansion Stage (capable of standing on your own) Briefly describe your business, product, service, and associated technology * Please list the type of services/assistance your company will require: * How did you hear about us? Additional comments: I verify that this information is current, accurate, and that it may be confirmed. Signature * Date
