BLDC Application

COVID Relief Technical Assistance Pre-Screening Form
Please provide all the required information below to apply for the COVID relief technical assistance grant provided by the Greensboro United Way in partnership with Black Lamb Development Corporation. If your business is selected to participate you will receive one on one and/or group technical assistance. A BLDC representative will contact you to discuss our business assistance program in further detail. In the event you are not chosen to participate we will add you to our mailing list to receive informative business literature and self-help tips.
Business Name*
Enter Your Business Name
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Best Contact Number*

Area CodePhone Number
E-mail*
Company Website
www.bizname.com
What is your industry?*
Please Select One
If other was selected on the previous question, please specify here:
Example: Transportation
How long have you been in business?*
Enter Number Ex. 5 Years
How many employees do you currently have (1099 or other)?*
Enter Number Ex. 10 Employees
What was your total sales/revenue for 2018?*
Enter Number Ex. $125,000
What was your total sales/revenue for 2019?*
Enter Number Ex. $175,000
What were your projected sales for 2020?*
Enter Number Ex. $200,000
Please estimate your monthly decrease in revenue you've experienced as a result of COVID-19?*

10-25%25-40%40-55%More Than 55%
Please estimate What percent of the loss makes up your total revenue?*
Enter Number Ex. 25%
Have you ever worked with a business consultant / coach?*
Please verify that you are human*
Should be Empty:

COVID Relief Technical Assistance Pre-Screening Form