Sistahbiz Demographic & Firmographic Questionnaire

Sistahbiz Demographic & Firmographic Questionnaire

We would like to ask some questions about you and your business. The information you provide will be kept confidential and used only by Sistahbiz and our program partners to serve you more effectively. Please answer all questions to the best of your knowledge.

Contact Information

First Name*

Last Name*

Email*

Phone*

Business Address*

Business Address 2

Business State*

Select

Business City*

Business Zip Code*

Business Country*

Select

Reference(s)*

How did you hear about Sistahbiz?

Select

Other Reference(s)

Do you have a Sistahbiz Membership?*

Select

About You

We aim to understand and honor the diverse backgrounds' of our sistahs. Please help us out by completing the questions below.

Date of Birth*

Race*

To which race(s) do you most identify? Select all that apply.

Select

Nationality*

Which nationalities do you most identify with? Select all that apply.

Select

Foreign Born

We love celebrating our sistahs all over the world. Please select the checkbox below if you were born outside of the United States.

Gender Identity*

Select

Gender Identity (Specify)

Sexual Orientation*

Select

Sexual Orientation (specify)*

Pronouns*

Select

Pronouns (specify)

Household Size*

How many family members, or others, live in your household, including yourself? Format: Numbers Only

Household Income*

Remember to include all sources of income for your household (eg. employment, retirement, government assistance). Please do not include your business revenue in this number. Format: Numbers Only

About Your Business

Business Name*

Physical Business Location*

Do you have a physical location for your business?

Select

Monthly Business Location Cost*

How much is the monthly cost to maintain your office or business location?

Business Start Date*

When did you start your business?

Currently in Operation*

Select

Business Operation Type*

Select or enter value

Industry*

Select

Products and Services*

Describe the products you offer.

Business Type*

Select

Customer Type*

Select

Entity Type*

Select

Certificate of Good Standing*

Provide the link to your certificate of good standing (proof of business registration in your state).

Government Certifications*

Select all that apply.

Select

# Employees and Contractors*

Select

Hiring in Last 3 Months*

Have you hired any new employees or contractors in the last three months?

Select

Year-To-Date Revenues*

How much were your annual revenues this year?

Select

Last Year Annual Revenues*

How much were your annual revenues in 2019? Enter numbers only.

Select

Business Revenue Streams*

Are your business revenue streams dependent upon events or travel and will funds cover lost revenue due to cancellations. If yes, please explain.

Capital Types Secured*

Select

Capital Amount Secured*

Select

Business Financial Statements*

Provide links to financials statements or sales reports.