Startup Financial Needs Assessment Form

Company Information

Field	Information
Company Name	[Your Company Name]
Industry Sector	[Industry Sector]
Contact Person	[Contact Person]
Email	[Your Company Email]
Phone Number	[Your Company Number]
Address	[Your Company Address]
Website	[Your Company Website]
Social Media Handles	[Your Company Social Media]

Financial Needs Assessment

Category	Estimated Cost (USD)	Funding Source (if any)
Startup Costs	$50,000	Bootstrap funding
Product Development	$20,000	Angel investor
Technology Infrastructure	$15,000	Personal savings
Legal and Compliance	$10,000	Venture capital
Marketing and Branding	$30,000	Crowdfunding
Initial Inventory	$5,000	Loan from family
Operating Expenses
Rent and Utilities	$12,000	Revenue from sales
Personnel Costs	$40,000	Grant funding
Marketing Expenses	$25,000
Administrative Expenses	$8,000
Research and Development	$15,000
Other (Specify)	$0
Total Financial Needs	$220,000

Comments/Notes:

Declaration

I confirm that the information provided above is accurate to the best of my knowledge.

Signature:

Date:

[Your Company Name] assures confidentiality of the provided information and will only use it for the purpose of assessing financial needs and providing relevant assistance.

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