Business Information
Company Name
*
Where is your business primarily located?
*
Clark County, Nevada
North Las Vegas, Nevada
Henderson, Nevada
Las Vegas, Nevada
Reno, Nevada
Carson City, Nevada
Boulder City, Nevada
Other
Address
*
Postal code
*
Do you have a NV State Business License?
*
Pick from the drop down
Yes
Not Yet
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How much revenue did your company make in the past 12 months?
*
Pick from dropdown
$0 - $9,999
$10,000 - $24,999
$25,000 - $99,999
$100,000 - $249,999
$250,000 - $999,999
$1mm - $4,999,999
$5mm+
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Business Description
*
Owner Information
First Name
*
Last Name
*
Phone
*
Email
*
Is the owner a current or former member of the Armed Forces?
*
Yes
No
Is the business 51% minority-owned?
*
Yes
No
Have you previously received business or professional coaching or mentorship?
Yes
No
Is the business 51% woman-owned?
*
Yes
No
Race / Ethnicity
*
Hispanic / Latino
Native Hawaiian
American Indian or Alaskan Native
Asian
Black / African American
White
Other Pacific Islander
Other
Prefer not to say
Gender
*
Male
Female
Other / Non-Binary
Prefer not to say
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