Entrepreneur Accelerator Application

Date of Application *

First Name *

Last Name *

Email *

Address *

State *

City *

Postal code *

Phone

Website *

Year Business Established *

Are you paying yourself a salary? *

What Industry? *

Business Legal Entity *

% of Ownership of Your Company *

Please provide a brief description (three sentences max) of your company's primary line of products or services *

Not counting yourself, how many direct employees do you have? *

Number of Contractors (1099) *

Using your current business model, what do you project the company annual revenue to be five years from today? *

From the selections below, indicate your long-term plans for your business. *

What are you hoping to gain from being a member of the Entrepreneur Accelerator? *

Who do you view as a direct competitor? Please list any companies and/or specific industries and the services they provide.*

Please upload a rolling 12 month or previous calendar year P&L report.

Upload your preferred headshot – We will use this headshot for social media & our website

How do you prefer to consume information?

Physical Books

Audio Books

Both

If you are approved to participate in this program, please indicate how you would like to pay the EA membership fee: *

Full Amount / Credit Card

Quarterly / Credit Card

Monthly / Credit Card

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.