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Home
About Us
Calendar
Contact Us
President’s Letter
FAQ
Memberships
Join Now
Member Directory
Membership Benefits
Forms
Directory Questionnaire
Chamber’s Intake Questionnaire
Website Intake Form New
USBC
US Black Chamber
Requirements Guide
Directory/Certification
Donate
Gala 2023
Gala Tickets
Gala Ticket Waitlist
Log In
Member Intake Questionnaire
Date
Contact Name
Email Address
Phone Number
Race
American Indian/Native American
Asian/Pacific Islander
Black/African American
Caucasian
Hispanic
Other
If other, please specify
Active Duty
Yes
No
Veteran
Yes
No
Spouse
Yes
No
Disabled
Yes
No
Service Disabled
Yes
No
Business Name
Type Of Business
Gross Revenue
Firm Address
Tax ID
State Of Incorporation
Date Started
Website
Legal Entity
C-Corp
S-Corp
Proprietorship
LLC
Partnership
Not Defined
Are there any affiliated entities
Number of employees
Certifications
ByBlack
8(a)
Hubzone
SDVOSB
Woman Owned
Other
List All Owners, Officers, and % Ownership
What are the areas in your business where you would like assistance (i.e., business plan, website development, accoounting services, etc.)
Send
Form 103/April 2023