Company Information
 Business Name: Click here to enter text.
 Physical Address: Click here to enter text.
 Mailing Address (if different from Physical Address): Click here to enter text.
 Business Phone Number: Click here to enter text.
 Company Website Address: Click here to enter text.
 Other Social Media Used (i.e. links): Click here to enter text.
 Year Business Started: Click here to enter text.
 Year of Business’ Acquisition (if different from business start date): Click here to enter text.
 Company’s Primary Products/Services Description: Click here to enter text.
 Describe who Purchases Your Company’s Products/Services: Click here to enter text.
 Minority Certification(s) held: Click here to enter text.
Personal Information
 Applicant Name: Click here to enter text.
 Title: Click here to enter text.
 Mobile Phone Number: Click here to enter text.
 Email Address: Click here to enter text.
Ownership Information
 Legal Structure: Click here to enter text.
 Ownership structure: (“Tab” to add more owner’s information)
Owner’s Name
Ownership (%)
Acquired Ownership By
Financial Information
2014
2015
2016
Revenue
Net Income

Senior Leadership and employees (including CEO):
Employee Name
Title
Years of Service
Additional Questions
1. What are your growth plans (indicate Projected Revenue) Yr. 1, Yr.2, Yr. 3? Describe how you
plan to achieve these growth rates.
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2. What other goals do you have for the business over the next 1-3 years?
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3. Share any business improvement actions taken in last 24 months.
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4. What are your expectations of the Eastern Bank BEI Program? Why would you like to participate
in the BEI Program?
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5. What has been your experience working with advisors – either formally or informally? What
worked well? What did not work well?
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6. Do you have a Business Plan written/updated in the last five years?
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Technical Assistance You Would Like
☐ Leadership Development
☐ Strategic/Growth Plan Development
☐ Financial Systems Analysis and Reporting
☐ Access to Growth Capital/Access to Working Capital
☐ Organizational Development
☐ Joint Venture Assistance
☐ Market Analysis
☐ Operational Analysis and Improvement
☐ IT/Technology Infrastructure Analysis
☐ Process/Operations Improvement
☐ Other: Click here to enter text.