Intake Form


General Information

First Name *
Last Name *
How did you hear about WACIF?

Business Information

Business/Org Name
Status
Date Formed (MM/DD/YYYY)
Filing State
Organized
IRS Status
DUNS#
NAICS Code
SIC
EIN
DC Ward#
Business/Organization Street Address
Business/Organization City
Business/Organization State
Business/Organization Zip
Phone *
Fax
Email *
Website
Please provide a brief description of your business and its products and/or services:
What type of one-on-one technical assistance are you seeking? *
 Human Resources Capital Sources/Access to Capital
 Financial Needs Assessment
 Loan Packaging
 Loan Sourcing
 Strategic Management Growth Strategy Business Start-up
 Business Plan
 Real Estate Acquisition
 Contract Assistance
 Licensing and Compliance
 Sales and Marketing
 Accounting
 Technology Franchises
 Buy/Sell Business
 Regulatory Info
 Access to Capital
 Certifications
 Post Loan Closing Technical Assistance
 Other

Personal Information

Personal Street Address
Personal City
Personal State
Personal Zip
DC Ward #
Phone
Cell Phone
Email
Gender
Are you Female Head of Household?
Is English your primary language?
If no, what is your primary language?
Do you identify as Hispanic / Latino?
Please check all race categories that apply:
 Black/African American
 American Indian/Alaska Native
 White
 Asian
 Native Hawaiian/Other Pacific Islander

Individual Technical Assistance Agreement

By submitting the above information I hereby guarantee it is true and correct to the best of my knowledge. By requesting technical assistance services from the Washington Area Community Investment Fund, Inc. (WACIF) I agree to provide all appropriate information requested by my counselor in connection with these services. I also agree to provide relevant accomplishment data/status information requested by WACIF in compliance with funder requirements. I understand that all information will be kept confidential. I further understand that the counselor(s) agrees not to: 1) recommend goods or services from sources in which he/she has an interest; or 2) accept fees or commissions from third parties developing from this counseling relationship. In consideration of the counselor(s) furnishing the technical assistance, I waive all claims against WACIF and, if applicable, SBA personnel and SBA Resource Partners and host organizations that may arise from this assistance.

If I receive assistance through an SBA-supported program, I agree to cooperate should I be selected to participate in surveys designed to evaluate SBA services. I permit SBA or its agent the use of my name and address for SBA surveys and information mailings regarding SBA products and services. I understand that any information disclosed will be held in strict confidence. (SBA will not provide your personal information to commercial entities.)

 
Documents

WACIF Investor Agreement

Success Stories
"When no other money source would give us an opportunity, WACIF said 'yes'. We were given hope again, and for that, we are deeply appreciative." - Michael Smith, Owner of Smith and Sons, LLC
"When no other money source would give us an opportunity, WACIF said 'yes'. We were given hope again, and for that, we are deeply appreciative." - Michael Smith, Owner of Smith and Sons, LLC
"Without WACIF's support, I would be in the unemployment line." - Barrett Johnson, Founder of Niyyah Electrical Contractors
"Without WACIF's support, I would be in the unemployment line." - Barrett Johnson, Founder of Niyyah Electrical Contractors
"We could not have started up without WACIF's help. We are incredibly grateful for their assistance." - Jim Schulman, Founder of Community Forklift
"We could not have started up without WACIF's help. We are incredibly grateful for their assistance." - Jim Schulman, Founder of Community Forklift
See More Success Stories
Local Events

Location! Location! Location! - Small Business Real Estate

May 24, 2012
6:00pm - 7:30pm

2100 MLK Ave SE - Office of Councilmember Marion Barry

Every business - from Walmart to McDonalds to YOURS - needs to put time and effort into the thought of where to open. Learn the tried and true principles used when choosing the best place for your business.

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Small Business Loan Day

May 29, 2012
6:30pm - 8:30pm

Sit and speak one-on-one with a lender!

Reserve your spot today for a one-on-one session with a small business lender - FREE, tailored and honest, financing advice.

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