Application for Back End Support

Contact Information
Business Name*
Business Federal Tax ID (Note: this will be used for identification purposes if you are enrolled in the program)*
Business Address*

Street Address

Street Address Line 2

CityState

Zip Code
Does this business have two equal owners?*

NoYes
Primary Owner Name*

First NameLast Name
Primary Owner Race/Ethnicity *
Primary Owner Gender*
Co-Owner Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email*
example@example.com
Co-Owner Race/Ethnicity
Co-owner Gender
Is your business Minority Business Enterprise certified?*

Certified with the cityCertified with the stateCertified with the federal governmentNot DEI certified
What business certification(s) do you have? (women, minority, etc.)
Are you a 51% or more Minority-owned business?*
Are you a women and/or men owned business?*
Are you a veteran-owned business?*
Are you a disabled-owned business?*

Business Information
Industry Sector*
Please describe your business' products or services:*
Please describe your most urgent current business need:*
How long has your business been in operation?*
What is your business' approximate net annual revenue? (Please enter one number-even if its $0.00)*
Business Website
Business Social Media Link(s)
How many employees does your business have?*
What percent of your business serves/comes from Wilmington, DE?*

More than 50%Less than 50%None
Where does your business primarily operate?*

Home Based/OnlineCommercial Property

Contact Information