Small Business Application

Company Name *

Applicant Name *

Applicant Designation *

Email *

How long have you been in business? *

What is your industry type? *

Are you a startup company? *

Yes

No

Do you have outstanding tax liens? *

Yes

No

Have you had any bankruptcies or foreclosures in the past 3 years? *

Yes

No

Do you have any recent charge-offs or settlements? *

Yes

No

Are you a minority owned business? *

Yes

No

Are you a sole proprietor? *

Yes

No

Do you abide by a strict code of Business Ethics and Transparency with your current customers and vendors? *

Yes

No

Do you currently host a physical office space or do you mostly work remote? *

Physical Office

Work Remotely

How many employees do you currently have on file? *

Are you a registered 501c non-profit business? *

Yes

No

Have you purchased a domain name or web hosting? *

Yes

No

Have you worked with a technology, marketing, or branding service provider before? *

Yes

No

Who is your domain or hosting provider?

What services did you acquire in the past?

Website Development

Mobile application Development

Social Media Marketing

Search Engine Optimization

Marketing Material

Branding

Video Production

Please check all that apply.

If approved by the Change Control Board Committee, what is your maximum payment amount? *

This does not take into consideration the overall project cost, rather a gauge of you Information Technology allocation budget for each month if approved.

If approved by the Change Control Board Committee, what is the maximum monthly payment amount that you can allocate for your project? *

This does not take into consideration the overall project cost, rather a gauge of you Information Technology allocation budget for each month if approved.

Please tell us about the mission and goals of your project. *

Please select a tentative date for the completion of your project.

Is this the first time that you are conducting business with Strategia Solutions? *

Yes

No

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