POC Small Business Network Web Intake Survey
Please enter your name.
Street address of your home
Zip code your home is located in.
Do you identify as Black and/or Latino?
If you would like to offer greater detail to your response above, how do you racially and/or ethnically identify?
Has your business made at least one sale since it started?
What month and year did your business start? (enter in MM/YYYY format) Estimates are acceptable too.
What is the name of your business?
Street address of your business
Zip code your business is located in.
What is your email address?
What's the best phone number we can reach you at?
Generally, when is the best time to call you?
Let us know what is the best way to get in contact with you.
If you selected Social Media for the previous question, what platform(s) are you/your business on? Under what name can we find you/it?