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OneAZ Intake Form
Data Entry By:
Date
Registered on our Website
Yes
No
Business Headquarters
-
Arizona
California
Nevada
Navajo Nation
Other
Select
What other state?
Participant’s Full Name
First
Middle
Last
Name of Business
(if applicable)
Email
Phone
Website
(if applicable)
Do they have?
Business Plan
Capability Statement
Specific Areas of Interest and/or Recommendation
Financial Education
Business Insurance
Loan/Line of Credit
Investor Opportunities
Workshops
Export Assistance
Patents & Trademarks
Certifications
Public (Government)/Private Contracting Opportunities
Basic One-on-One Consulting
Industry
-
Agriculture
Manufacturing
Arts and Crafts
Information Technology
Transportation & Warehousing
Construction
Real Estate
Consulting Services
Education
Food Services
Health & Wellness
Other
Select
What other industry?
Contracts Section
Did Client Receive a Contract?
Yes
No
Contract From?
Contract Amount?
Type of Contract?
-
Government
Private
Other
Contract From?
Contract Amount?
Type of Contract?
-
Government
Private
Other
Contract From?
Contract Amount?
Type of Contract?
-
Government
Private
Other
Capital Section
Did the Client Receive Money (“Capital”) ?
Yes
No
What kind of money did they recieve?
-
Payment bonds
Performance bonds
Bid bonds
Traditional loan
Line of Credit
Grants for Small Businesses
Other capital raised
Select one
Amount?
From Whom?
Date
What kind of money did they recieve?
-
Payment bonds
Performance bonds
Bid bonds
Traditional loan
Line of Credit
Grants for Small Businesses
Other capital raised
Select one
Amount?
From Whom?
Date
What kind of money did they recieve?
-
Payment bonds
Performance bonds
Bid bonds
Traditional loan
Line of Credit
Grants for Small Businesses
Other capital raised
Select one
Amount?
From Whom?
Date
What kind of money did they recieve?
-
Payment bonds
Performance bonds
Bid bonds
Traditional loan
Line of Credit
Grants for Small Businesses
Other capital raised
Select one
Amount?
From Whom?
Date
What kind of money did they recieve?
-
Payment bonds
Performance bonds
Bid bonds
Traditional loan
Line of Credit
Grants for Small Businesses
Other capital raised
Select one
Amount?
From Whom?
Date
What kind of money did they recieve?
-
Payment bonds
Performance bonds
Bid bonds
Traditional loan
Line of Credit
Grants for Small Businesses
Other capital raised
Select one
Amount?
(ex. from local cities and municipalities)
From Whom?
Date
What kind of money did they recieve?
-
Payment bonds
Performance bonds
Bid bonds
Traditional loan
Line of Credit
Grants for Small Businesses
Other capital raised
Select one
Amount?
(ex. from local cities and municipalities)
From Whom?
Date
Notes
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