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I. Business Information
Business Name:
*
Name of Contact:
*
Business Address
Street:
*
City:
*
State:
*
Zip code:
*
Phone Number:
*
Councilmanic District Number:
Contact Person
Name | Title
*
Email Address
*
II. Nature of Business
Form of Ownership:
*
Sole Proprietor
Limited Liability Corp
Partnership
Corporation
Other
Date Business established:
*
+
Federal Tax ID# (if applicable):
Or Social Security Number:
NAICS Code:
*
DUNNS#/UEI (Unique Entity Identifier):
III. Ownership
Please List All Owners
Name
Title
% of Ownership
Email
1.
Name
Title
% of Ownership
Email
2.
Name
Title
% of Ownership
Email
3.
Name
Title
% of Ownership
Email
4.
Name
Title
% of Ownership
Email
The following questions are for gathering statistical data only. If the business is owned and controlled primarily by individuals who are identified in any of the following categories, please check all the categories that apply:
*
African American/Black-Owned
Minority-Owned
Asian/Pasific Islander-Owned
Caucasian-Owned
Hispanic/Latino-Owned
Native American-Owned
Woman-Owned
Veteran-Owned
Certified MBE
County-Based
Prefer not to answer
IV. Business Operations & Employment
Type of services provided:
*