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. Question Title * 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 Question Title * 2. Company and Contact Information Applicant Name and Title Company Name Mobile Phone Number Company Address Company City/Town Company State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Company ZIP/Postal Code Company Phone Number Company Email Address Company Website Question Title * 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? Question Title * 4. Is your company a certified? DBE MBE SB VOSB WBE Other (please specify) Question Title * 5. Are Financial Statements Available? Yes No N/A Question Title * 6. Please list your gross revenue for the following years: 2017 2016 2015 N/A Question Title * 7. Describe your company's products and services or your expertise: Question Title * 8. Describe your company's greatest growth challenges: Question Title * 9. Initial thoughts on how we might be able to help - what are you looking for? Question Title * 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: Question Title * 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) Done