Bluefield Commercialization Station Application
The Bluefield Commercialization Station was established to assist early-stage manufacturing ventures in the Bluefield, WV region. Its services range from business coaching/mentoring to professional,educational, and capital resources that can assist you with growing your business. The City also has access to other space for incubation of non-manufacturing related businesses. Please answer the following questions (and provide the requested information) so your application can be evaluated and the appropriate support package can be developed to meet your needs.
1. Company Name:
2. Type of Corporation:
3. Current Address:
4. Phone Number(s):
6. Is this new business affiliated (as a subsidiarydivision) with an established business? If yes, name of parent business:
7. Date business was established:
8. Are you pursing this business on a full-time basis or part-time basis?
9. Are you pursing this business as one of the following:
Tenant: Business receiving services from the Commercialization Station that are physically located on site
Client: Business receiving services from the Commercialization Station that are not physically located on site
Prospect: Business who is looking to become involved on site with the Commercialization Station in the future
10. Brief description of business and products or services offered:
11. Please provide a brief description of your challenges or needs (50 words or less). If you are unsure, say “unsure”.
12. What are the critical business objectives for the next three (3) months?
13. In general terms, what are the business goals for year one?
14. In general terms, what are the business goals for year two?
15. At what stage of development are the products or services you wish to market through your business?
Saleable Products/Services Stage
16. List of officers/directors/advisors:
17. Number of Employees [Full-Time and Part-Time]:
18. Do you have a management team established for this venture? If yes, which areas of expertise does the management team possess?
Prior experience with the product or service being developed
Technical expertise necessary to develop the product/service
Small business management expertise
Marketing/Sales experience in the industry (or related industry) of
product/service is to be sold
Prior experience in raising capital for a new venture
19. Number of Employees Projected in (# of years):
20. Type and square feet of space required:
21. Special facility requirements (electrical,ventilation, floor load, etc.):
22. Target date for relocation into the incubator:
23. Estimated required support services from the incubator:
General Business Assistance
Marketing/Sales - Domestic
Marketing/Sales - International
Intellectual Property Support (Patents, Trademarks, etc.)
Contract Development and Review
Corporate Formation and Support
International (e.g. contract support, formation, IP, import/export, etc.)
Management Team Development
Access to engineers, scientists, programmers, designers, etc. to assist in product development
Access to specialized components (e.g. sensors, chips, switches, transmitters, batteries, etc.)
Building a Prototype
Solving a problem in your production process
Locating a company to manufacture your product
Locating equipment you can use to manufacture your product
Locating a company to test your product
Locating equipment you can use to test your product
24. Are you willing to disclose sufficient information about your business to allow our staff and its advisors to properly assess your needs and develop the appropriate support package?
25. Internet service needs and possible bandwidth capacity:
26. Affiliation with college/university (if applicable, state yes/no with affiliation):
27. How did you hear about this incubator?
28. What do you hope to achieve by establishing a relationship with this incubator?
29. Additional comments:
Please include a copy of your current business plan, annual report, brochures, and/or any other relevant information. If you do not have a business plan and need assistance in developing one, please indicate that under the “additional comments” section above.
DECLARATION: I declare that to the best of my knowledge the information I have provided on this form is correct and that I have not omitted any facts that may have a bearing on my application. I understand that falsification of qualifications or information may lead to dismissal of my application.
Please include full name as a digital signature
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