PowerLink Discovery Form

Thank you for your interest in PowerLink. Below is our business discovery form we ask you to complete so we can better assist you and your business.

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* 1. I am interested in learning more about:

Attending a Think Tank as a Business Owner or Presenter

Attending a Think Tank as an Audience Member

Becoming an Advisor

Obtaining a PowerLink Custom Advisory Board

Joining a CEO Circle

Other

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* 2. Company and Contact Information

Applicant Name and Title

Company Name

Mobile Phone Number

Company Address

Company City/Town

Company State/Province

Company ZIP/Postal Code

Company Phone Number

Company Email Address

Company Website

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* 3. Complete the following information:

Year Company was Founded

% of Company Owned by Applicant

Number of Full-Time Employees

Number of Part-Time Employees

Number Sub-Contracted (1099 Employees)

Industry

List any other owners and their percentage of ownership:

What is your business structure and what areas do you operate?

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* 4. Is your company a certified?

DBE

MBE

VOSB

WBE

Other (please specify)

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* 5. Are Financial Statements Available?

Yes

N/A

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* 6. Please list your gross revenue for the following years:

2017

2016

2015

N/A

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* 7. Describe your company's products and services or your expertise:

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* 8. Describe your company's greatest growth challenges:

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* 9. Initial thoughts on how we might be able to help - what are you looking for?

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* 10. List up to three best dates/times on Wednesday mornings or Fridays to schedule a 1 hour follow-up interview to discuss your business in more detail:

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* 11. How did you first hear about PowerLink?

News article

Word-of-mouth referral from friend

Online search (e.g., Google, Yahoo, Bing)

Online forum/discussion board

Social media (e.g., Facebook, Twitter)

Other (please specify)