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.
AsianBlack or African AmericanHispanic, Latino, or SpanishMiddle Eastern or North AfricanAmerican Indian or Alaska NativeNative Hawaiian or Other Pacific IslanderWhiteOtherPrefer not to say
DisabledImmigrantLGBTQ+Limited English ProficiencyReturning CitizenRefugee/internally displacedNonePrefer not to sayOther
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
YesNo
YesNoPrefer not to sayNot Applicable
YesNoPrefer not to sayNot Applicable
YesNoPrefer not to sayNot Applicable
Sole ProprietorshipPartnershipLimited Liability Company (LLC)C-CorporationS-CorpNonprofitUnregistered BusinessOther
Not Revenue Generating$1- $25,000$25,001 - $50,000$50,001 - $100,000$100,001 - $200,000$200,001 - $500,000$500,001 - $1,000,000$1,000,000 +
Monthly Commercial Rent ($) (applicable to tenants only) Type, $0 if not applicable
Certified Business Enterprise (CBE) by DC DSLBDDisadvantaged Business Enterprise (DBE) by US DOTMinority Business Enterprise (MBE) by NMSDCWomen Owned Small Business (WOSB) by SBAHistorically Underutilized Business (HUB) Zone by SBASBA 8(a) CertificationSmall, Women-owned, and Minority-owned (SWaM) Business by VA SBSDLocal Disadvantaged Business Enterprise (LDBE) by MWAAAirport Concessions Disadvantaged Business Enterprise (ACDBE) by US DOTNo CertificationsOther
YesNo
Business Start-upt Loan SourcingStrategic ManagementGrowth ManagementSales & MarketingLicensing/Compliance InformationHuman ResourcesAccounting AssistanceLegal AssistanceQuickbooksGuidance: Lease ReviewGuidance: Business Acquistion/SaleGuidance: Real EstateFinancial Needs AssessmentOther
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