Where innovation gets down to business.

Client Application

Tampa Bay Innovation Center Application:

Submitting an application is the first step to obtaining assistance from the Tampa Bay Innovation Center.    Information from the applicant will help the selection committee determine if the company’s needs are compatible with available Tampa Bay Innovation Center resources.  Please be sure to complete this application in its entirety for prompt consideration.  Additional information may be requested as part of the application process.  Proprietary information will be treated as confidential.   All personal, financial and other references will be checked.

 

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Program applying for:

Incubator   Accelerator
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Location applying for:

Young-Rainey STAR Center   St. Petersburg Technology Incubator
Clearwater VIP (Technology District)   Virtual/Off-site
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Company Name:

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Principal Officer/Title:

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Name of person completing this application:

Contact Information for Primary

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Name:

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Title:

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Home Address:

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City:

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State:

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Zip:

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Primary Phone:

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Fax:

Company Information

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Description of product/service:

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Background of Officers:

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Date established:

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Company form:

S-Corp   Sole Proprietor   Other
C-Corp   LLC
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Status of Company:

Start-up   Product Development
Prototype   Full Operation
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Current Sales Revenue:

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Number of employees (FT/PT):

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Financing to Date:

Personal   Venture Capital
Private Investors   Other
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Plans for future rounds of financing:

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Status of business plan:

Not started   Partial   Completed
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Why company will be located in Tampa Bay region:

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Space requirements: Square footage for - office, manufacturing:

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Special facility requirements (electrical, ventilation, floor load, etc.):

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Desired date for occupation:

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Tax ID Number:

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North American Industrial Classification (NAICS). If you don't know what your NAICS code is, please click here.

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Primary services requested:

Consulting Services   Access to Capital
Telecommunications   Facility Space
Strategic Partners/Alliances   Other
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Intellectual Property status:

Patent Pending   Patent   Exclusive License
Copyright   Non-exclusive License   Copyright Pending
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Applicant hereby acknowledges that its application to and submission of information to the Review Committee of the Tampa Bay Innovation Center does not guarantee admission into the incubator program nor does it create any rights in applicant to future consideration. The Review Committee retains full discretion as to admission into the Program and reserves the right to reject any applicant for any reason.  Applicant hereby waives any right of appeal or legal action against any and all parties associated with the Incubator, including but not limited to Pinellas County, Pinellas County Industrial Development Authority, Pinellas County Economic Development Authority, Tampa Bay Innovation Center and the member of the Review Committee. All applications will be held in confidence and will be retained in the Review Committee’s files unless otherwise requested in writing by applicant.

Applicant agrees to indemnify, defend and hold harmless the Tampa Bay Innovation Center,  its directors, officers, employees, operator, consultants and any Governmental agencies associated with the Incubator from any and all claims, actions, causes of action, damages and liabilities asserted against the aforementioned individuals or entities arising out of or in any way connected with the activities and services provided by the Incubator, including, but not limited to, the provision of space, training or classes.

Do you acknowledge that you have read and acknowledge the above disclaimer?

Yes   No

 

Applicant shall pay an application fee of five hundred dollars ($500) to Tampa Bay Innovation Center as part of the vetting process.  In the event that the applicant is not accepted as a candidate for the business incubator, Tampa Bay Innovation Center shall refund five hundred dollars ($500) of the application fee.  If the applicant is accepted as a candidate for the business incubator the applicant will have 30 days to enter into a contract with Tampa Bay Innovation Center or will forfeit the five hundred dollar ($500) application fee.  If the applicant enters into the contract prior to 30 days of acceptance, the $500 applicant fee will be applied towards security deposit.

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