Entrepreneur of the Year Submission Form

To be completed by Nominees only.

- First Name*
- Last Name*
- Job Title*
- Business Name*
- Business Address*
- Work Phone Number*
- Email Address*
- Business Website*
- Number Of Years In Business?*
- Annual Gross Revenue 2021*
- Annual Gross Revenue 2022*
- Projected Annual Gross Revenue 2023*
- Was your business profitable last year?
- Full Time*
- Part Time
- Other
- How many do you plan to add in the next 12 months, if any?
- What are your short term (3-5 years) goals?*
- What are your long term (5 years or more) goals?*
- How would you describe your business and leadership philosophy and how do you measure success?*
- What differentiates your business from your competitors?*
- What activities are you involved in that benefit your community? (i.e. civic organizations, social clubs, volunteering, financial support etc.)
- Signature Of Owner/Operator*
- Date*
  MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.