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2. Basic Information
4. First Name*
6. Last Name*
8. Phone Number*
10. Are you a City of Buffalo resident?*

    1. Yes
    2. No
12. Home Address*
14. Business Information
16. DBA or Entity Name*
18. Year of Incorporation*
20. Ownership in the Company*
22. Business Address*
24. Certified M/WBE*

    1. Yes
    2. No
26. Is it in NYS?*

    1. Yes
    2. No
28. Is it in City of Buffalo*

    1. Yes
    2. No
30. Describe your Business in a few sentences*
32. What industry is your business in?*
34. What specific Services or Products does your company offer?*
36. Who is your target audience?*
38. List of Social Media Handles and Websites*
40. Financial Information
42. How much Income has your business made in the last 6 months?*

    1. $0 - $49,999
    2. $50,000 - $99,999
    3. $100,000 +
44. How much Income did your business make in 2019?*

    1. $0 - $49,999
    2. $50,000 - $99,999
    3. $100,000 +
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45. 1. Receive an email copy of this form.
46. Email address

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47. Submit

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