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
example@example.com
Gender*
Cell Phone Number*
Please enter a valid phone number.
Race/Ethnicity*

AsianBlack or African AmericanHispanic, Latino, or SpanishMiddle Eastern or North AfricanAmerican Indian or Alaska NativeNative Hawaiian or Other Pacific IslanderWhiteOtherPrefer not to say
Are you part of any of these populations? (check all that apply)

DisabledImmigrantLGBTQ+Limited English ProficiencyReturning CitizenRefugee/internally displacedNonePrefer not to sayOther
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*
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.
Mobile Phone Number*
Please enter a valid phone number.
Brief Description of the Business
Are you the business owner?*

YesNo
Minority Owned?*

YesNoPrefer not to sayNot Applicable
Woman Owned?*

YesNoPrefer not to sayNot Applicable
Veteran Owned?*

YesNoPrefer not to sayNot Applicable
Business Type*

Sole ProprietorshipPartnershipLimited Liability Company (LLC)C-CorporationS-CorpNonprofitUnregistered BusinessOther
Annual Revenue*

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
Local and Federal Government Certifications*

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
Are you interested in becoming certified?*

YesNo
Business Services (Select all that apply)

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