The 1899 Project
First Name
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Last Name
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Email Address
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Phone Number
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Website
Street Address
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Apartment, suite, etc
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City
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State/Province
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ZIP / Postal Code
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Race
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Native American or Alaskan Native
Native Hawaiian or Pacific Islander
Asian
White
Black or African American
Gender
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Male
Female
How Did You Hear About Us?
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Friend
Social Media
Business Owner
Remix Web Site
Other Client
Educational Institution
Local Economic Development Official
Chamber of Commerce
Magazine/Newspaper
Word of Mouth
Television/Radio
Internet (specify below)
Other (specify below)
Additional Details
Date Business Founded
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Have your registered your business?
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Yes
No
Business Name
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Type of Business (Choose Primary Categories)
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Service
Retail
Wholesale
Manufacturer
Real Estate
Food Services
Finance & Insurance
Arts & Entertainment
Educational Services
Other
Number of Employees
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What is the legal entity of your business?
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Sole Proprietorship
S-Corporation
Corporation
LLC
Partnership
Other
Please provide a BRIEF description of your business or business idea
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How the fund would help support your business/idea (150 words max)
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0 / 150
Describe your business, product, or service and what differentiates it from your competitors.
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What problems are you trying to solve?
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Describe your solution to the problem described above
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How does your company make money?
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How does your business support your community?
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Signature
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Date
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Submit
