MAMS Business Intake Form

Business Intake Form

Please complete prior to business consultation. Thank you.
*PLEASE NOTE THIS IS NOT A LOAN APPLICATION
Personal Information
First Name (Business Owner)
Last Name (Business Owner)
Address (Home)
City
State
Zipcode
Ward
Email
Gender
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Race/Ethnicity
Are you part of any of these populations? (check all that apply)

Other
What type of business location do you operate?
Property Information
Business Occupancy
Property Owner/Landlord Name
Property Owner/Landlord Address*
Property Owner/Landlord City
Property Owner/Landlord State
Property Owner/Landlord Postal Code
Property Owner/Landlord Email
Phone Number
Format: (000) 000-0000.
Business Information
Company Name (If none enter, N/A)
Address (Business)
City (Business)
State (Business)
Zipcode (Business)
Ward
State of Incorporation
Website
Email
example@example.com
Year Established (if applicable)
Employer Identification Number (EIN)
DUNS Number
If the company does not have a DUNS Number, enter "NA".
Number of Employees/Jobs at Intake (including the business owner)
Number of Full-Time Employees
Number of Part-Time Employees
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Brief Description of the Business
Are you the business owner?
Minority Owned?
Woman Owned?
Veteran Owned?
Business Type

Other
Annual Revenue
Monthly Commercial Rent ($) (applicable to tenants only) Type, $0 if not applicable
Local and Federal Government Certifications

Other
Are you interested in becoming certified?
Business Services (Select all that apply)

Other
Is there any additional information that you would like to share with us? Please enter below. (Optional)
Should be Empty:

Business Intake Form

*PLEASE NOTE THIS IS NOT A LOAN APPLICATION

Personal Information

Property Information

Business Information