Funding Assessment

Funding Assessment Form

Do not enter any proprietary or confidential information.

* = required

Contact first name *
Contact last name *
Company name *
Title
Email address *
County *
Phone
Cell phone
Address *
City *
State *
Zip code *

Check if "yes"

My company is a certified African American or Hispanic owned business.
My company is a business-to-business or business-to-government organization.
My company operates primarily within the Cincinnati USA Regional Chamber service area.
My company will grow significantly as a result of receiving Fund financing.
Jobs will be created or retained if my company receives Fund financing.

I have received business consulting or related services from these entities:
(Ctrl+click to select all that apply)

 

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