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* 1. Name

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* 2. Phone

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* 3. Email Address

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* 4. Home Address

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* 5. Business Name

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* 6. Business Phone Number

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* 7. Business Address

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* 8. Business Idea/Description

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* 9. Business Stage: (Pre-Startup or Operating Business)

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* 10. Amount of time in business or years of experience:

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* 11. Number of employees:

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* 12. How much money do you need to raise for your business?

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* 13. What will the money be used for? (Example: renovations, equipment, rent a location, purchase materials, hire new staff, etc.)

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* 14. What will be the outcome if you successfully reach your funding goal?

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* 15. Why did you start your business?

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* 16. What is the vision for your company?

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* 17. What sets your business/product apart from your competitors? Please elaborate.

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* 18. What are some of your current business challenges?

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* 19. Identify 3 or more reasons why someone would want to donate to your campaign?

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* 20. Which crowdfunding platform are you most interested in: Kiva Zip, Indiegogo, Kickstarter, other

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* 21. Please identify at least 3 successful crowdfunding campaigns with similar products /services to yours from Kickstarter/Indiegogo/RocketHub. What incentives did they have?

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* 22. What type of rewards can you offer to funders? (i.e. Your business Product or Services, thank you card, Put contributors name on your website, premium packages)

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* 23. Do you have pictures or videos of you and your business/products in it?

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* 24. Can you identify who in your networks will support you in getting to 25%-50% of your goal? Please make a list of those people.

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* 25. Please list any media outlets and partners (blogs, newspapers, organizations) that may help you market your campaign.

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* 26. Do you have an email list? (Yes/ No). If yes, how many email contacts?

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* 27. Do you have a facebook account? (Yes/ No). If yes, how many followers/friends?

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* 28. Do you have a Twitter account? (Yes/ No). If yes, how many?

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* 29. Do you have a Tumblr account? (Yes/ No). If yes, how many?

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* 30. Do you have a Instagram account? (Yes/ No). If yes, how many?

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* 31. Do you have a Linkedin account? (Yes/ No). If yes, how many followers?

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