The Naples Accelerator Apply for Membership Company Name*Type of Corporation & State of IncorporationEmployer Identification Number (EIN)Applicant First Name*Full legal first name required.Applicant Middle Name*Full legal middle name required.Applicant Last Name*Full legal last name required.Title*Phone*Email* Website Personal Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Address (if different from home address) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Type of Membership RequestedVirtual ($75)Coworking ($125)Reserved Workspace ($250)Half Office ($600)Full Office ($925)See memberships page for more information Target date for relocation into the Accelerator NAICS IdentificationVisit https://www.naics.com/search/ to find your NAICS Identification number and descriptionNAIC #NAIC DescriptionAbout Your BusinessEconomic Incubators, Inc. (Naples Accelerator) was established to assist second-stage soft landing technology ventures in Southwest Florida. Its services range from business coaching/mentoring to professional, education and capital resources that can assist you with growing your business. Please answer the following questions so your application can be evaluated and the appropriate support package can be developed to meet your needs. Brief description of business and products or services offered*List of officers/directors/advisors*How many people (including yourself) are employed in the business?*Number of employees projected in 2 years*How long have you been in the business?*Do you have a completed business plan for this venture?*YesNoDo you have a well-developed concept paper for this venture?YesNoUpload Your Business Plan/Well-Developed Concept Paper Drop files here or Please provide a brief description of your challenges or needs (50 words or less). If you are unsure, say “unsure”In general terms, what are the business goals for year one?What do you hope to achieve by establishing a relationship with the Naples Accelerator?How did you hear about the Naples Accelerator?*Areas of Assistance NeededPlease identify the type(s) of assistance you are seeking* Physical or Virtual Office Space General Business Assistance Market Research Marketing/Sales – Domestic Marketing/Sales – International Business Plan Preparation Legal Services Intellectual Property Support (Patents, Trademarks, etc. Contract Development and Review Corporate Formation and Support International Financial Services Management/Operations Human Resources Management Team Development Business Advocacy Financing (Debt) Financing (Equity) Do you have funds budgeted to pay for these services?*YesNoConfidentialityYou may request that your project information (including information contained in this application) be confidential per F.S. 288.075, Confidentiality of Records for a 12 month period, with an additional 12 month extension available upon request for projects still under consideration. If you wish to request confidentiality for information contained within the General Project Overview to be held confidential pursuant to section 288.075, Florida Statutes, please submit with this application a request on company letterhead and signed by an authorized company officer including the following statement: On behalf of (Legal Name of Applicant), please accept this letter as a request for all documents, records, reports, correspondence, conversations, applications, data and other sources of information concerning our business plans, interests, or intention to evaluate or locate in Florida as well as other trade secrets, identification, account, and registration numbers, and proprietary confidential business information be held confidential pursuant to section 288.075, Florida Statutes for a period of 12 months after the date of receipt of this request for confidentiality or until the information is otherwise disclosed, whichever occurs first. This request covers all applicable economic development agencies, including but not limited to Enterprise Florida and the Department of Economic OpportunityCertification and ReleaseThe Naples Accelerator is managed by Economic Incubators Inc. (EII), a Florida not-for-profit corporation. All of the statements made in this application are true, accurate and complete to the best of my knowledge. I understand that any false statement or material omission may lead to disqualification of this application and/or termination of the Accelerator Services Agreement. I understand that this application may be denied after review, and in consideration of said review and other good and valuable consideration, I agree to waive all rights of administrative and judicial review of said denial and agree that I may seek a review by the Naples Accelerator’s Chief Executive Officer, whose decision will be the final determination with regard to my application for participation in the Naples Accelerator. I understand this application and supporting materials may be reviewed by EII and its Accelerator Application Committee and I release said information for all purposes related thereto. I authorize EII and its officers or assignees to contact any references given, as well as to secure credit and/or criminal background reports on the persons applying for participation in the Naples Accelerator. *Note: the provisions of the Fair Credit Reporting Act may be applicable if a credit report is obtained and considered. I understand that no landlord-tenant, agency or employment relationship will be created by completion of this application or acceptance into the Naples Accelerator. I am authorized to make the statements contained herein and to act on behalf of the persons listed herein to apply for use of the Naples Accelerator. If the person(s) applying herein are accepted to use the Naples Accelerator, the undersigned authorizes the use of the logos and names of the person(s) listed herein for the purpose of publicizing said acceptance and marketing the Naples Accelerator. To the best of my knowledge and belief, all information submitted in connection herewith is complete and accurate and contains no misstatements, misrepresentations or omissions of material facts.Do you have any pending or prior felony charges or convictions?* Yes No I have read and agree to the terms & conditions outlined here* Yes No Electronic Signature* First Last Please electronically sign your application by typing your full name. You will not be able to submit your application without electronically signing and agreeing to the terms & conditions.