Build to Boom Enrollment Form

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Basic Details

Name(Required)

First Last

Email Address(Required)

Enter Email Confirm Email

Mobile Number(Required)

Name of Business(Required)

Number of Years in Business (generating revenue)(Required)

The total numbers of years your business has been exchanging products/services for payments (to generate revenue)?

Date Business Was Established(Required)

Number of Full-Time Employees(Required)

Number of Part-Time Employees(Required)

Number of 1099 Contractors(Required)

Do you run your business full or part time?(Required)

Full time

Part time

Current Business Structure(Required)

Sole Proprietor

LLC

Partnership

Corporation

Nonprofit

No Formal Structure

How is this business operated?(Required)

E-commerce

Brick & Mortar

Mobile

Virtual

Is your business located in Nashville on Jefferson or Buchanan Street?(Required)

Yes

Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Have you established an EIN?(Required)

Yes

I don’t know what that is or why I need it

Do you have a business plan?(Required)

Yes

Last year's total business revenue?(Required)

$0 – $5,000

$5,001 – $10,000

$10,001 – $25,000

$25,001 – $50,000

$50,001 – $75,000

$75,001 – $100,000

$100,000+

What is your projected business revenue for this year?(Required)

$0 – $5,000

$5,001 – $10,000

$10,001 – $25,000

$25,001 – $50,000

$50,001 – $75,000

$75,001 – $100,000

$100,000+

Personal & Business Finance

Do you have a personal budget?(Required)

Yes

Yes, I created one but don’t use it

How would you rate your personal credit?(Required)

Poor

Fair

Good

Very Good

Exceptional

Do you have a business budget?(Required)

Yes

Yes, I created one but don’t use it

Have you established any business credit?(Required)

Yes

Have you obtained a Dun and Bradstreet number?(Required)

Yes

I don’t know what that is or why I need one

Do you have a business bank account?(Required)

Yes

No, I Haven’t Used Any Banking For My Business

No, I Am Using My Personal Bank Account For Business Transactions

I Qualify For One But Need Help

I Don’t Think I Qualify For One

Bank Name

Do you have a relationship with a banker?(Required)

Yes

Have you created sales projections for your business?(Required)

Yes

Have you previously applied for funding for your business?(Required)

Yes

What was the outcome of the loan you previously applied for?

If your loan was denied, please include the reason below.

Approved

Denied

Currently Pending

Please explain the reason for the denial.(Required)

Are you currently seeking or in need of loan funding for your business within the next 12 months?(Required)

Yes

Maybe

How much funding do you need?(Required)

Under $5,000

$5,000 – $15,000

$15,000 – $50,000

$50,000 – $100,000

Over $100,000

How do you accept payments from customers/clients? (Select all that apply)

Cash

Check

PayPal

Venmo

Cash App

Square

Stripe

Shopify

QuickBooks Invoicing

Bank Transfer/Zelle

Other

Do you issue invoices to clients?(Required)

Yes

Do you sell products, services, or both?(Required)

Products

Services

Both

Do you pay any contractors or employees?(Required)

Employees

Contractors

Both

None

Do you use a payroll system?(Required)

Yes

What payroll system do you use?(Required)

What are your main business expense categories?(Required)

Inventory

Software

Marketing

Travel

Rent

Insurance

Professional Services

Contractors

Other

Are you currently interested in business lending opportunities for your business?

Yes

Maybe

Bookkeeping

Are you currently bookkeeping for your business?(Required)

Yes

Which bookkeeping system does your business currently use?(Required)

Please do not create a new bookkeeping system during the program.

None

Excel/Sheets

Quickbooks

Wave

Xero

Are you actively reconciling your books on a monthly basis?(Required)

Yes

Can you produce a profit and loss statement for your business?(Required)

Yes

Can you produce a balance sheet for your business?(Required)

Yes

What is your priority for financial support?(Required)

Bookkeeping Setup

Bookkeeping Catch-Up

Financial Statement Cleanup & Preparation

Business & Personal Finance Separation Setup

Cash Flow Planning Session

Pricing & Profitability Review

Tax Filing Readiness

Tax Strategy Consultation

Capital Access Preparation

What is your second priority for financial support?(Required)

Bookkeeping Setup

Bookkeeping Catch-Up

Financial Statement Cleanup & Preparation

Business & Personal Finance Separation Setup

Cash Flow Planning Session

Pricing & Profitability Review

Tax Filing Readiness

Tax Strategy Consultation

Capital Access Preparation

Marketing

Please describe your business in two sentences or less. Please specify what products or services you provide.(Required)

Choose Your Business Industry(Required)

Business Website

Business Facebook Page Link

Business Instagram Handle

Business Linkedin Page

Business Tiktok Handle

Business Youtube Page Link

Who are your major competitors?

Business Owner Data

This section is collect data that must be reported to our grant funder for this program.

Age Group(Required)

18-24 years old

25-34 years old

35-44 years old

45-54 years old

55+ years old

Race(Required)

Hispanic or Latino

American Indian or Alaskan Native

Asian

Native Hawaiian or Other Pacific Islander

Black or African American

White

Two or more races

Other

Race(Required)

Ethnicity(Required)

Hispanic or Latino

Not Hispanic or Latino

Gender(Required)

Male

Female

Non-Binary

Transgender

Decline to State

Household Income Level(Required)

Under $15,000

$15,000 to $24,999

$25,000 to $34,999

$35,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 to $124,999

$125,000 to $149,999

$150,000 to $199,999

$200,000 and over

Important: Please enter an accurate shipping address. Your program certificate will be mailed to the address you provide, so be sure it is complete and correct, including any apartment, suite, or unit number.

Shipping Address(Required)

Street Address Address Line 2 City State ZIP Code

What organization referred you?

Boomin U

Black Business Boom

Black Chamber of Memphis

Communities Unlimited

Corner to Corner

Columbus Chamber

Cummins

Detroit Development Fund

Grameen

Jacksonville Black Chamber

Low Country Local First

MEDA

Nashville Black Chamber

NBIC

NDC

Palmetto Goodwill

Pitch Feast

River City Capital

WEOP

Other

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