Business Health Check

Legal Business Name:
EIN Number:
Type of Business:
DBA (Doing Business As):
Preferred Salutation:
Owner's First Name:
Owner's Last Name:
Other Business Owners:
Street Address:
Zip Code:
Business Phone Number:
Mobile Phone Number:
Mailing Address:
Business is::
Month and Year Formed:
Organization Type:
Is Your Business::
Preferred Method of Communication::
Are you LSDBE Certified in DC?:
Are you 8(a) certified by SBA?:
Are you located in a HUBZone?:
Empowerment or Enterprise Zone (EZEC)?:
Government contracts or subcontracts?:
Government Contracts Explanation:
Please check all categories that apply:
What's your gender::
Are you legally disabled?:
Military Status:
Primary Language:
Number of full-time employees?:
Number of part-time employees?:
Describe other employment arrangements:
Square footage of your business:
Property owner or management information:
Do you own or lease?:
Lease Expiration Date:
Lease type:
Rent per year?:
Upcoming real estate needs?:
Real estate needs explanation:
Do you have a website?:
Website Address:
Do you use social media sites?:
How often do you use social media?:
Other ways you promote your business:
Business Management Assistance Needs?:
Financial Assistance Needs:
Marketing Assistance Needs:
Governmental Assistance Needs:
Other Assistance Needs:
Client Name: