5x5x5 Application Form

Step 1 of 5

20%

Contact Information

Yes
No
Yes
No
Yes
No

Step 2 of 5

40%

Co-Founder Information ( Owner )

Female

Male

Non-binary and Gender Non-Conforming

Identifies as LGBTQ

Veteran

Certified Women Owned Business

Person with Disabilities

Under 25 years old

25-35 years old

36-49 years old

50+ years old

Prefer not to answer

This owner works 40+ hours per week in the business.
This owner works 10-25 hours per week in the business.
This owner works less than 10 hours per week in the business.
This owner does not work in the business.
Yes
No

Step 3 of 5

60%

Business Information

Sole Propriator
S Corporation
C Corporation
Limited Liability Company
None of the Above
Accomodations

Constructions

Finance

Food Service

Health Care

Insurance

Manufacturing

Real Estate

Rental and Leasing

Retail

Social Assistance

Transportation

Warehouse

Whole Sale

0
1 - 4
5 - 9
10 - 24
25 - 29
100+
Operations Agreement
Shareholder Agreement
Partnership Agreement
None
Not applicable to my business
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Yes
No

Step 4 of 5

80%

Past Funding


Funding Goal and Request

Step 5 of 5

100%

Business Model and Growth

I am evaluating a business idea for viability
I launched my business but have not made any sales yet
I am running my business and started making sales within the last 12 months
I have been running my business and making sales for more than 12 months
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