NJSBDC Economic Impact Form

NJSBDC Economic Impact Form
As part of the New Jersey Small Business Development Centers (NJSBDC) grant funding process, the Small Business Administration (SBA) has asked the centers to gather basic information from business owners who have received assistance from our center in regards to capital infusion: money (i.e., loans, crowd funding, personal funds, fixed assets, etc.) that has been invested in your business to date by the owner, partners and/or investors. Capturing this critical aggregate statistical data helps inform lawmakers who are assessing the economic conditions New Jersey small businesses face. The information you provide on this form is completely confidential and will only be available to the SBA who may provide it to Congress, anonymously, when developing future relief or assistance programs.
Date*
MM/DD/YYYY
MM slash DD slash YYYY
Client Name*
First Last
Business Start Information
Business Name*
When did you register your business with the state, and/or a local government entity, such as a county clerk’s office?*
MM/DD/YYYY
If you don't remember the date, use this NJ Business Name Search Tool.
Capital Infusion into the Business:
How much has been invested in the business (equity capital – owners cash)?*
Have you secured a loan from a lender? If yes, how much?*
Have you secured any Disaster Assistance Loans (i.e., PPP, EIDL, etc.)? If yes, how much?*
How much equity have you raised from investors?*
Other sources/assets contributed to business (e.g. Grants, Equipment, etc.). Include the Amount and Description*
How many Employees do you have?*
Full-time = ?
Part time = ?
If just yourself, enter "SELF".
Your Signature (Please sign here)*
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

Business Start Information

Capital Infusion into the Business: