Owner's Information
Your Full Name
*
Primary Email Address
*
Secondary Email Address
Primary Phone Number
*
-
Area Code
Phone Number
Secondary Phone Number
-
Area Code
Phone Number
What is your primary language?
*
When is the best time to call?
*
Mornings: 8:00 am - 11:00 am
Afternoons: 1:00 pm - 4:00 pm
Early Evenings: 5:00 pm - 7:00 pm
Are you able to meet virtually or face-to-face during the day (before 6 pm)?
*
Yes
No
Business Information
What is the legal name of your business?
*
Do you have an alternative business name or DBA?
*
Are you a minority owned and operated business?
*
Yes
No
How many hours a week do you spend actively working on your business?
*
Business Physical Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Mailing Address (if different)
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
How long have you been in business?
*
What kind of business do you own?
*
About how much revenue did you make last year (estimate)?
*
Does your business solve a unique problem?
*
What pain points are you currently experiencing inside your business?
*
What do you want to achieve through this program?
*
How many employees do you have?
*
Average Salary
*
Is the business currently generating revenue? If Yes, how much?
*
Is the business a franchise?
*
Yes
No
Do you engage in a consulting or "coaching" business?
*
Yes
No
Is the business a non-profit organization?
*
Yes
No
Website & Social Media
If you do not have one of the items below, simply type “None” in the text box shown.
Website Address
*
Facebook Page
*
Twitter Page
*
Instagram Page
*
Blog Address
*
Other Social Media Channels
*
Appointment cancellations require 24 hour notice. Would this be a problem?
*
Yes
No
How did you hear about the Minority Small Business Program?
*
Submit Your Application
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