Service Application Form

* = Required Information

Timeline to Begin Business Development *

Contact Person Name *

Email Address*

Contact Number 10am to 3pm *

Contact Number after 5 pm *

Name of Consultant or Agent *

Seeking to Start A Business

Yes

What State?

Industry

Existing Business Corporate Information:

Owner Name

Contact Number

Corporation Name

Industry

Date Incorporated

State of Formation

Corporate Physical Address

Corporate Phone

Extension

Year End Income

YTD Profits

Web Address

Credibility:

Have you Amount Allocated for Services?

Yes

Budget for Services

Funding Needs for Business Development or/and Contract Procurement Services:

Personal:

Equifax Score No

Experian Score

TransUnion

Novus My Fico

Late Payments

Collections or Judgement

Bankruptcy Discharge Date

Number of Inquiries the last 6 months

Annual Income

Type of Professional Licenses

Degree

Status: Military

Corporate:

Equifax Score No

Experian Score

DNB Score

Pay-Net Score

Late Payments

Collections or Judgement

Bankruptcy Discharge Date

Number of Inquiries the last 6 months

Year End Income

Last Six Months Average Deposits

Industry

Regulatory Licenses

SBA Certifications

Will you require Funding for Services?

Yes

Purchase

Amount

Partnership

Refinance

Amount Allocated for Services

Amount Invested

Seeking Funding

Amount

Liens

Bankrupt

TYPE	SERVICES	RATES
Intake and Consultation	Business Assessment Performance Analysis Business Application Consultation	$500 $2500 $500 $500
Applications	Loans Credit Business Transfer Corporate Kit Incorporate Non Profit Registered Agent EIN Exemption State Tax ID Permit County Licenses State Licensing Compliance Registrations General Consumer Accounts Business Accounts Registrations Licensing Certification	$500 $100 $1500 $300 $250 $1500 $350 $75 $850 $75 $800 $150 hr $500 $75 pg $50 pg $25 pg $100.00 0 to1hr $100.00 per hour $200.00 per hour $100.00 per hour $100.00 per hour
3 Months of Coaching	Four 30 minute sessions	$450.00
6 Months of Coaching	Four 30 minute sessions	$450.00
9 Months of Coaching	Four 30 minute sessions	$400.00
Intake Assessment	Per Hour	$250.00
Business Plans	Investors/Lender $15 pg SBA Approved $20 pg	$2500 $3500
Credit	Building	$3500
Policies & Procedures	Non Regulated	Contracted
Policies & Procedures	Accredited/Regulated	Contracted
Skilled Policies & Procedures	Accredited/Regulated	Contracted
Procedures	Commercial	Contracted
Programs	Development	Contracted
Manuals & Handbooks	Employee Human Resource Consumer	Contracted
Manuals & Handbooks Regulated	Employee Human Resource Consumer	Contracted
Commercial Regulated Manuals	Operations Human Resource	Contracted
Marketing Branding	PR Kit & Advertisement	Contracted
Training	Instructed/Materials	$100hr
Website Design Basic	$10 pg $3 pg	$800 $800
Web Max Optimization	Major Engines	$800
Flyer	Design	$75
Flyer	Content	$150
Brochure	Design	$75
Brochure	Content	$150
Post Card	Designs	$75
Post Card	Content	$100
Business Card	Design	$75
Business Data Base	up to 10 Functions	$2000
Commercial Data Base	Over 10 Functions	$200 hr
Registrations	Search Engines on-line	$800.00
Provider Enrollment	Private	$2500
Corporations	Seasoned	Per Contract
Business Sales	Marketing	Per Contract
Contractual Securities	Bids/Proposals	Per Contract
Equipment/Furnishings	Inventory	Per Item
Materials/Supplies	Stock & Inventory	Per Item
Corporate	Mergers & Acquisitions	Per Contract
Re engineering	Contracts & Services	Per Contract
Agents	Real-estate Insurance Public Relations	Commission Commission 50hr
Professionals	Movers Heat & Air Contractors Electricians Plumbers Marketing Agents Public Relations Interior Designers Builders General Contractors Inspectors Trainers Expert Consultants Business Coach Technicians	Per Hour or Contract Per Hour or Contract Per Hour or Contract Per Hour or Contract Per Hour or Contract Per Hour or Contract Per Contract Per Contract Per hr. $150.00 hr $250 hr $150 hr $50 hr
	Compliance Team	$300 hr
	Brokers/Lenders/Investors	Fee & Commission per Application
	Writers	$150 hr
	Certified Public Accountant	Per C

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