Construction Business Outreach Survey

I. BUSINESS INFORMATION

1. Legal Business Name: *

2. DBA (Doing Business As), if applicable:

3. Primary Business Address:

Address Line 1

Address Line 2

City

Zip/Postal Code

4. Business Telephone Number: *

5. Business Email Address: *

6. Company Website (if applicable)

7. Date of Business Establishment (MM/DD/YYYY): *

Format: MM/dd/yyyy

8. Federal Employer Identification Number (EIN): *

9. D-U-N-S Number (if available): *

II. OWNERSHIP INFORMATION

1. Is the business at least 51% minority owned? *

Yes No

2. Racial/Ethnic Background of Majority Owner(s): (Select all that apply) *

Black or African American Hispanic or Latino Native American or Alaska Native Asian or Pacific Islander White Other (Please Specify):

2.b Racial/Ethnic Background (if you chose other)

3. Gender of Majority Owner(s): *

Male Female Non- Binary Prefer not to disclose

4. Business Ownership Structure:

Sole Proprietorship Limited Liability Company (LLC) Partnership Corporation (C-Corp or S-Corp) Other (Please Specify):

4.b Business Ownership Structure: (If you chose other)

III. BUSINESS OPERATIONS

1. Primary Industry Classification

2. Brief Description of Services Provided:

3. NAICS Code: *

4.a Number of Employees (Full-time) *

4.b Number of Employees (Part-time) *

IV. AUTHORIZED COMPANY REPRESENTATIVE

Name Block - Full

Title

First Name

Last Name

Suffix

Telephone Number: *

Email Address: *

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