BizEX Contact Form

Tell Us About Your Business

Your Name: * Required

Email Address: * Required

Business Address:

Street Address:

Zip Code: * Required

Business Stage: * Required

Planning / Considering Starting a Business
Preparing to Start a Business
Relocating an Existing Business
Growing / Expanding a Business
Seeking Resources / Help
Other (please specify): 

Business Description: * Required

Business Type: * Required

Registered to and/or operated from my home
In a commercial establishment

Tell Us About Your Yourself

What Race Do You Identify With? * Required

American Indian and Alaska Native
Asian
Black or African American
Native Hawaiian and Other Pacific Islander
White
Two or more races
Prefer not to say

What Ethnicity Do You Identify With? * Required

Hispanic/Latino
Non-Hispanic/non-Latino
Prefer not to say

What Gender Do You Identify With? * Required

Female
Male
Prefer not to say

Is the Business Owner (Or Prospective Owner) a Veteran? * Required

Yes
No
Prefer not to say

Does the Business Owner (Or Prospective Owner) Have a Disability? * Required

Yes
No
Prefer not to say