BBOC BLACK BUSINESS CENSUS

Business Owner*

First NameLast Name

Business Name*

When did you start your business? Example: 4/10/2018*

What is your Business Structure: Sole Entrepreneur, LLC, Non-Profit, S-Corp, C-Corp, Partnership? *

Contact Number*

E-mail*

example@example.com

Website

Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Demographic Ownership*

Business Location: Do You Own, Rent, or are Home-Based? *

Who is your Target Audience? (Demographically: Age, Race etc), )*

Do you sell Product(s), Service(s), or both? Please Describe in detail Below. *

Type of Business*

Annual Gross*

Number of Full-Time Employees, if applicable? *

Number of Part-Time Employees, if applicable? *

Number of 1099 Contractors, If applicable? *

Are you a certified vendor with the City of Charlotte, Mecklenburg County, or the Stare of NC? If so, which demographic category are you registered? Feel free to List any other Certifications like ByBlack.us.

What percentage of the company is owned by you? 100%, 50%, 25%, Less than 25%, etc*

List the names of owners, and their % of ownership, if applicable.

What is Your Website & Social Media Handle(s)? Sample Format: Https://www.BBOCLT.com Https://Facebook.com/YOURBUSINESS IG @OfficialBBOCLT

What are your Greatest Challenges as a Business Owner?

How can BBOC, the City, County and other local orgs, better assist your business ?

If You Would Like for BBOC to create you a promo card (see above), please provide us your LOGO! We will send within 48hours and ask that you share on your social media accounts and urge fellow BOB’s to register. BBOC will also share your promo card on our social media account(s) as a Thank You!

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Data Release Notice: BBOC’s Black Business Census will ensure the City, County, Local, & National Organizations have the most up-to-date data related to Black-Owned businesses located in Mecklenburg County. BBOC may publicize overall data and statistics, and may provide overall data and statistics to partners including; The City of Charlotte, Mecklenburg County and Official BBOC Partners. However, BBOC will not publicize or share your individual business information, with the city, county or partners without your direct permission. When and if permission is needed, BBOC will contact you and request your permission. Please confirm you have read and fully understand this Data Release Notice by Typing Your Full Name Below

BBOC’s BLACK BUSINESS CENSUS

Ex: Promo Card