Section 1

Business Owner/Principal Information
Owner 1 First Name*
Owner 1 Last Name*
Email*
Phone*
Address*
City*
State*
Zip*
Owner 2 First Name
Owner 2 Last Name
Email
Phone
Address
City
State
Zip
Business Information
Business Name
Business Email
Business Phone
Business Fax
Address
City
State
Zip
Business Industry RetailServiceWholesaleManufacturingConstructionOnlineOther
Business History New (Under 12 months) Existing (Over 12 months)
Has the business met all of the legal requirements necessary to become established? YesNo
Date Business Established
Number of Full Time Employees
Number of Part Time Employees
Time Federal Tax ID Number
NAICS Code (If known)
Type of Business/Organization Sole Proprietorship PartnershipS CorporationC CorporationLLCNot for ProfitNot yet established
Website and Social Media Links (If it applies)

Personal Financial Summary

Funders require the CAOWNY to show the proof of income of the individual/s that are receiving services. The CAOWNY will not penalize you or deny your application because of the amount of your gross (before tax) or net (after tax) income. Your income will not hinder us from approving your application for services. Submit your proof of income in the form of employment pay stub, a letter that shows the monthly/annual benefits that you receive from social services, SSI, SSD, unemployment benefits etc. Proof of income can be submitted with this application, emailed (pjames@caowny.org) or faxed (716-332-1015).

Business Financial Summary

Does the business, owners, have any personal or business judgments, unsettled lawsuits or major disputes?
YesNo
Has the business or any of the owners been involved in a bankruptcy or insolvency proceeding? YesNo
Does the business or any of the owners, owe any taxes for the prior to the current year? YesNo

Existing Business

2019 Revenues
2019 Profits
2020 Revenues
2020 Profits

SECTION 2 - BUSINESS PLAN DEVELOPMENT

Have you completed a business plan? (If yes, please attach a copy of your business plan)YesNo
Upload Plan:
When and by whom was your business plan prepared?
If you have not completed a business plan, would you like information on assistance available to help you prepare a business plan? YesNo
Have you completed any CAOWNY business development workshops? YesNo
Have you completed any other business workshops? YesNo
If yes, who sponsored the workshop?
How did you hear about the CAOWNY Business Development Series?

SECTION 3 - DEMOGRAPHIC INFORMATION

You are not required to furnish this information, but are encouraged to do so because the CAOWNY’s funders may request demographic information about whose being served. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.

Gender MaleFemaleTransgenderOther
Ethnicity Hispanic or LatinoNot Hispanic or Latino
Race (Mark one or more) Black or African AmericanIndianWhiteAlaskanNative AmericanAsianHawaiianPacific IslanderOther

SECTION 4 - NEEDS ASSESSMENT

What are some of the challenges that you believe are preventing you from starting or growing your business?
Areas of assistance Business Start-UpNew BusinessCapital NeedsMarketing/SalesGovernment ProcurementAccounting and RecordsDocumentationFinancial AnalysisCost ControlInventory ControlPersonnelComputerTechnologyInternational TradeBusiness LiquidationOther
Do you have a personal budget? YesNo
Do you have an emergency fund? YesNo
Do you have retirement plan or fund? YesNo
Do you have business insurance? YesNo
Do you have supervisory experience in the industry? YesNo

How much money do you need to start your businesses or project?

Financing Needs
Total Project Costs

Owner’s Contribution and Credit Score

Owner 1:
Owner 2:

SECTION 5 - CERTIFICATIONS & DISCLAIMERS

Please read the following certifications carefully and sign below. All company owners, officers, or
partners must sign below. If you have any questions, call CAOWNY at 716-332-3773 ext. 1407.

1. By my signature below, I authorize CAOWNY to research the company’s and its principal(s) history. I
give permission for the CAOWNY to take pictures of the business owner/s and/or representatives during
either zoom or in person workshops.
2. I give CAOWNY permission to include pictures of the owner/s or representative/s in the CAOWNY’s
newsletter, website and/or social media channels.
3. I certify that ownership of the company is at least 51% by U.S. citizens or persons admitted to the U.S. for
permanent residence.
4. Technical Assistance Disclaimer
CAOWNY may render technical assistance, directly or indirectly, to you based on information you provide, in
connection with management systems, internal controls, marketing plans, business plans, financial
projections and compilations. Such assistance and all statements made in connection therewith are for your
internal use only, and are not to be used or communicated in any manner whatsoever to third parties without
CAOWNY’s express written consent.
5. CAOWNY is in no way responsible for your use of this information, and makes no warranties
and representations in connection therewith except as expressly granted in writing.
You agree to indemnify and hold CAOWNY harmless in connection with the use or misuse of such
information, documents, representations or writing.

E-Signature (type your full name)
E-Signature 2(type your full name)