Business Intake Form

Please complete prior to business consultation. Thank you.

*PLEASE NOTE THIS IS NOT A LOAN APPLICATION

Personal Information

First name*

Last name*

Address (Home)*

City (Home)*

State (Home)*

Zip Code (Home)*

County (Home)*

Ward (if not in DC, Select "N/A")*

Gender*

Marital status*

Age Range*

Military status*

Household Income 2019*

Household Income 2020*

Criminal Record*

Highest Level of Education*

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*

Property Owner/Landlord Phone Number*

Business Information

Company Name (If none enter, N/A)*

Are you the business owner?*

Yes

Business Operating Status*

Address (Business)*

City (Business)*

State (Business)*

Zip Code (Business)*

County (Business)*

Ward (If business not located in DC, select "N/A")*

State of Incorporation*

Website URL

Email*

Year Established (if applicable)

Employer Identification Number (EIN)

Industry (NAICS)*

In what industry does your business operate?

DUNS Number*

If the company does not have a DUNS Number, enter "NA" below.

Number of Employees/Jobs at Intake (including the business owner)*

Number of Full-Time Employees*

Number of Part-Time Employees*

Business Phone Number*

Mobile Phone Number*

Brief Description of the Business*

Monthly Commercial Rent ($) (applicable to tenants only) Type, $0 if not applicable

Have you completed any Rehabilitation or construction projects to your property (i.e. Interior and exterior building improvements)?*

Has your business lost any jobs temporarily due to COVID-19?*

Business Certifications

Are you interested in becoming certified?*

Yes

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

How did you hear about Minnesota Avenue Main Street?*

Please specify how you heard about MAMS:*

Please provide specific information on how you heard about Wacif (for example, if a newspaper, please provide the name of newspaper)

Attestation

By submitting this form, I attest that, to the best of my knowledge, all information in the above referenced form is accurate and complete.

Furthermore, by submitting this form I attest to my understanding that this form is not an application for any of Wacif’s loan products and there is no guarantee of outcomes provided as it relates to my engagement with its advisory services.