Application

First name*

Last name*

Preferred Name

Date of birth*

Company name*

DBA*

Applicant Title*

Company Description*

Gender*

Male

Female

Race*

Work Phone, Ext*

Mobile phone number*

Email*

Company Website*

Company Address*

City*

State/Region*

Postal Code*

Percentage of Business you own*

Year Founded*

Year Acquired Ownership*

Number of Full Time Employees (Please count yourself)*

Number of Part Time Employees *

Number of Temporary/Independent Contractors*

Revenue 2 years ago*

Revenue Last Year*

Year-to-Date Gross Revenue*

Projected Revenue this Year*

Please explain your projected revenue sources.*

Rate Your Comfort Level with Technology*

Beginner

Intermediate

Advanced

Referral Source*

Please Describe Why You Want to be in the Baltimore Means Business Program*

Application Submission Date*

Year/Month/Day

Is your business a non-profit business?*

Photo Identification*

Cohort

Last 2 Years' Business Tax Return*

Proof of Legal Entity*