EatsPlace Client Intake Form
By completing this form and/or participating in a tour, I understand am requesting assistance from EatsPlace.  I agree to provide all appropriate information requested in connection with this assistance. All information will be kept confidential. In consideration of EatsPlace furnishing the products and/or services, I waive all claims against EatsPlace that may arise from this assistance.  Thank you!

EatsPlace is located in Washington DC. We work with clients located in Washington DC, Maryland and Virginia. We focus on food, agricultural and related businesses.
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Email *
Name (first name, last name) *
Is English your primary language? *
Do you identify as African-American, Latinx, and/or a woman (check all that apply)? *
Required
Date *
How did you hear about EatsPlace (check all that apply)? *
Required
Business / Organization Name *
Status
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Date Formed: (mm/dd/yyyy)
MM
/
DD
/
YYYY
 Filing State: (2 letter abbreviation)
Organized as:
Tax Status *
EIN:
NAICS Code:
DC Ward Number
Business/Organization Mailing Address: (if none, use personal address) *
Business Phone: *
Cell Phone: *
Website:
Social Media (Facebook / Instagram / Twitter)
Other: (Tiktok, LinkedIn, etc.)
Are you an owner of the business? *
List All Co-Owners/Partners: (Full names)
Do any of the Co-Owners/Partners identify as African American and/ or Lantinx? If so , which ones?
Do any of the Co-Owners/Partners identify as women? If so, which ones?
Are you LSDBE (Local, Small, and Disadvantaged Business Enterprise) certified?   *
Are you 8(a) or SBD certified by the US Small Business Administration? *
One sentence description of your concept: (How will you use EatsPlace or how can we help you?) *
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