MBA Fund 1 Web Intake Form vF

  • Minority Business Accelerator Fund 1

    Intake Application for Potential Investments
    • Contact Information 
    • Format: (000) 000-0000.
    • Are you the majority shareholder/owner of the business?
    • Business Information (Investment or Acquiring Company)  

    • Business Location
                    

    • Headquarters/Office Address
                    

    • Industry Sector
    • Rows

    • Number of Part-Time Employees
      Number of Full-Time Employees
      Number of Minority Employees
      Number of Female Employees

    • MBE Ownership
    • MBE Certified
    • WBE Certified
    • Financial Information  
    • The Business has sustained sales of $1M in Annualized Revenue

    • Financial Screenshot - Revenue
                       

    • Financial Screenshot - Net Profit
                       

    • Financial Screenshot - Cash Flow
                       

    • Rows
    • Customer Information 
    • The Business is a B2B and/or B2G solution
    • Fundraising Ask  
    • What is the proposed use (or uses) of these funds? (select all that apply)
    • Advisory Questions  
    • Management is receptive to new ideas and strategies by external parties
    • Please check if the business has:
    • Check MBA services you are interested in learning more about:
    • Final Steps  
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    • Confidentiality Agreement: Information will be held in strict confidence and shall not be used by the MBA and/ or the Cincinnati Chamber in any manner other than for the purpose for which it is intended.

    • Should be Empty: