New Client Enrollment Form

Contact Information

Full Name

Title / Role:

Business / Organization

Do you have an EIN?

If so place your EIN in field.

Do you need assistance in obtaining one?

Business Structure (For Profit, non profit etc...):

Cage & UEI Numbers:

Website

Business Email *

Phone *

Address

Busines Street Address:

City

State

Country

Postal code

Business Snapshot

Industry / Niche:

Please share your mission and speak from the heart:

Tell us about your company (brief overview):

How long have you been in business?

What inspired you to start your business or non profit:

Social Media Handles (IG, FB, TikTok, etc..)

Number of Employees / Contractors:

Certifications / Designations (e.g. Woman-Owned, 501c3, HUBZone, etc):

Grant Readiness

Have you received grants before? If yes , please list:

Do you have a business bank account?

Do you have a business plan or pitch deck?

Do you have a current Profit & Loss or (P&L) statement?

Are taxes and filings up to date?

Do you have a prepared budget for your next project?

Funding Purpose

What will the grant funds be used for?

Briefly describe your immediate funding need:

What is your ideal grant amount (range)?

Do you have matching funds available?

Impact and Community

Who do you serve? Describe your ideal customer or community:

What problems are you solving with your work?

Share an impact story or client success you're proud of:

Authorization

Do you authorize us to apply for grants on your behalf?

Are you open to being featured for a spotlight or marketing purposes?

Upload relevant docs: Business plan, P&L, Pitch Deck etc...

Date: