BAC Intake Form

 

Business Assistance Center
Client Profile
City of Dallas/HUD CDBG Program

Welcome to the Business Assistance Center (BAC) Program. This is a federally funded program through the City of Dallas, intended to assist Low-to-Moderate Income Persons who are interested in a Micro-Enterprise Business (with 5 employees or less including the business owner) or increasing the capacity of an existing Micro-Enterprise.

NOTE: Referrals made by the BAC do not constitute an endorsement by the BAC nor the City of Dallas for such services.

DISCLAIMER: The BAC provides persons with technical assistance for starting or improving their business through this program. Suggestions and assistance provided by the BAC do not constitute professional services or professional advice by the BAC nor the City of Dallas. For professional services or professional advice, you understand that you should consult with a professional.

To better serve you, please provide the following information. Place "NA" if the category or information does not apply to you:

CLIENT INFORMATION
Last Name *
First Name *
Middle Initial
Home Address *
Apartment/Unit #
City *
State *
Zip *
Business/Potential Address *
Apartment/Unit #
City *
State *
Zip *
Home Phone
Alternate Phone
Email Address *
Gender *
ETHNICITY (REQUIRED - Also make a selection from the "RACE" options) Note: Your selection will not effect your eligibility.
Hispanic or Latino(a):
RACE (REQUIRED) Note: Your selection will not effect your eligibility.
White
Black or African American
Asian & White
American Indian or Alaskan Native
Native Hawaiian or Other Pacific Islander
American Indian/Alaskan Native & White
Black/African American & White
American Indian/Alaskan Native & Black
Asian
Other
CLIENT BUSINESS INFORMATION
Are you currently in business? (if no, skip the next two)
If yes, how long?
Business Name
Are you interested in starting a new business?
OR expanding your existing business?
Type of business (Check all that apply):
Retail
Service
Wholesale
Manufacturing
Construction
Other
How did you hear about us? (Check all that apply):
Internet
Phone Directory
Newspaper
Word of Mouth
Radio
Chamber of Commerce
Bank
Other

Please type the above letters for verification purposes.
Please click submit only one time.  The transaction may take several seconds.

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