Please complete the form below, so we can learn more about you, your business, and your legal needs. Remember, the more information you can give us, the better we can determine whether or not we can assist you.

1. Your Contact Information

2. First Name(*)
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3. Last Name(*)
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4. Suffix
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5. Title
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6. Company
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7. Address 1
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8. Address 2
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9. City
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10. State
    AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingInvalid Input
11. Zip
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12. Email
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13. Work Phone
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14. Home Phone
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15. Mobile Phone
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16. Fax
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17. Website
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18. Gender
    MaleFemaleInvalid Input
19. Race
    African AmericanAsianBi-RacialCaucasianHispanicMulti-RacialNative AmericanOtherInvalid Input
20. Neighborhood
    East SideNorth SideSouth SideWest SideInvalid Input
21. Business
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22. Business Address
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23. City/State/Zip
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24. Would you like to receive information from the Institute for Justice Clinic?
    YesNoInvalid Input
25. Have you attended any classes on entrepreneurship yet?
    YesNoInvalid Input
26. Have you started a business before?
    YesNoInvalid Input
27. How did you hear about the IJ Clinic?
    Business Planning OrganizationCurrent or Former ClientOutreach PresentationWebsiteOtherInvalid Input
28.  

29. Founder Information

    Now, we’d like to know a little more about the owners of your business. How many people own your business? Please complete the information below for each business owner.

30. How many people own your business?
    1234Invalid Input

31. Founder 1

32. First Name
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33. Last Name
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34. How many people are in your household?
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35. What was the income for the entire household in the most recent tax year?
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36. Have you taken a business planning class?
    YesNoInvalid Input

37. Founder 2

38. First Name
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39. Last Name
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40. How many people are in your household?
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41. What was the income for the entire household in the most recent tax year?
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42. Have you taken a business planning class?
    YesNoInvalid Input

43. Founder 3

44. First Name
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45. Last Name
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46. How many people are in your household?
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47. What was the income for the entire household in the most recent tax year?
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48. Have you taken a business planning class?
    YesNoInvalid Input

49. Founder 4

50. First Name
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51. Last Name
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52. How many people are in your household?
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53. What was the income for the entire household in the most recent tax year?
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54. Have you taken a business planning class?
    YesNoInvalid Input
55.  

56. Business Information

57. Tell us more about your business or idea
58. Business Name(*)
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59. Address 1(*)
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60. Address 2
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61. City(*)
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62. State
    AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingInvalid Input
63. Zip(*)
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64. Phone
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65. Description
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66. Is the business in operation?
    YesNoInvalid Input
67. How many people currently work in your business (including yourself)
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68. If the business is already in operation, please answer these questions:
69. What was the total revenue of the business for the most recent tax year?
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70. What is the current average monthly revenue for the business?
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71. What was the business' profit/loss for the most recent tax year?
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72. What is the current average monthly profit/loss for the business?
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73. Do you have a written business plan?
    YesNoInvalid Input
74. What are the financing requirements of your business?(*)
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75. How do you plan to finance the business?
    Loans
    Private investors
    Personal funds
    Other
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76. Please explain
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77. What are your business' legal needs?
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78. Is there any other assistance you are seeking for your business?
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