Business Needs Assessment

Name
N/A

Required First Required Last
Company Name *
N/A
Title
N/A
Company Address
N/A

Required Street Address Address Line 2 Required City Required Region/Province Required Postal

Country
Company website
N/A
Office Phone
N/A

### ### ####
Mobile Phone *
N/A

### ### ####
Email *
N/A
Alternate Email
N/A
Preferred contact method *
N/A

Email
Phone
What stage is your company in? *
N/A

Not a Business Owner
Ideation - I have a business idea I am working on
Validation - I am testing my business idea (pre-revenue)
Efficiency - Business is operational and generating revenue
Scale - I want to exponentially grow my business
Exit - I am looking to sell my business
Tell us a bit about your company and what you sell or the idea that you have. *
N/A
What industry do you operate in? *
N/A
What type of business do you have? *
N/A

Unregistered
Sole Proprietor
Partnership
Corporation - For Profit
Corporation - Non Profit
Grassroots Non Profit
Charity
9 Digit Business Number *
N/A

Enter your 9 digit Business Identification number received from CRA.
Are you planning to register this year? *
N/A

Yes
No
Are you planning to Incorporate this year? *
N/A

Yes
No
How long has your business been operating? *
N/A

0 - 1
2 - 4
5 - 9
10+
How many employees do you have? *
N/A

0
1
2 - 4
5 - 9
10 - 19
20 +
Are you planning to hire this year? *
N/A

Yes
No
Depends
How much was your total revenue 2021? *
N/A

Pre-Revenue
$1 - $10,000
$10,001 - $50,000
$50,001 - $100,000
$100,001 - $500,000
$500,001 - $1,000,000
$1,000,001 +
Prefer not to say
What is your expected revenue for this year 2022? *
N/A

Pre-Revenue
$1 - $10,000
$10,001 - $50,000
$50,001 - $100,000
$100,001 - $500,000
$500,001 - $1,000,000
$1,000,001 +
Prefer not to say
Are you currently in need of additional funding? *
N/A

Yes
No
Use of funds *
N/A

What will the additional funding help you accomplish?
What type of funding are you interested in? Check all that apply *
N/A
Do you have access to our funding spreadsheet? *
N/A

Yes
If no you find the link below

https://drive.google.com/file/d/1sSza5XZnR2WgFdxDW1RqN5ocMATz8RBD/view?usp=sharing
Business Supports Needed? (check all that apply) *
N/A

Identify areas of business operations that you could use support with.
Relationship to ACBN *
N/A

Business Owner
Community Ally
Organization
How did you hear about ACBN? *
N/A

Attended Event
Sheridan EDGE
Facebook
Instagram
Twitter
LinkedIn
Email Newsletter
Friend or Colleague
Other
Which Level of Membership are you interested in? *
N/A

Free
Premier - $47 month
Premier - $500 year
N/A

I would like to receive newsletter, email notifications with the latest information and promotions from ACBN. * I would like to receive newsletter, email notifications with the latest information and promotions from ACBN. Required

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Business Needs Assessment

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