ECDI's Contractor Resource Center Intake Form
How Best To Reach You
First Name
Last Name
Email Address
Phone Number
Would you like to receive ECDI's Monthly Impact email?
Yes
No
Where Are You Located
Street Address
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
T
o protect your data, ECDI uses multiple safeguards including multi-factor authentication, server backups, best in class endpoint detection and response software to ensure your information is safe.
The information in this form is to be provided by individuals and business seeking technical assistance services from ECDI, a SBA Resource Partner. The information is collected to help ECDI's continuing improvement of business counseling programs, to ensure effective oversight and management of entrepreneurial development programs and grants, and to meet Congressional and Executive Branch reporting requirements.
Any information disclosed will be held in strict confidence. (ECDI will not provide your personal information to commercial entities.)
Demographic Information
Race
Asian
Black or African American
Middle Eastern
Native American/Alaska Native
Native Hawaiian/Other Pacific Islander
North African
White
Prefer not to say
Ethnicity
Hispanic/Latino
Non Hispanic/Latino
Prefer not to say
Sex
Male
Female
Prefer not to say
Annual Income
Approximate based off last tax filing.
Household Size
Including yourself.
Legal Name of Business
What date was your business established (or is planned to be launched):
Number of employees
Tax ID (i.e., Social Security # or Employer Identification #)
Income filed last tax year
What type of construction work does your business specialize in or plan to?
What stage is your business in?
Please select...
Idea stage
Start Up
Growth stage
Is your business insured?
Please select...
Yes
No
Do you possess any of the following:
Please select...
MBE Certification
Capability Statement
Business cards
Have you completed any contracts yet? If so, what kind?
Are there areas in managing or running a business which you seek further improvement or knowledge in?
What equipment or resources do you currently have?
Do you have any existing relationships with suppliers or contractors?
Please select...
Yes
No
How have you been funding your business so far?
Describe your current financial situation and if you can provide financial records.
Are you looking for funding?
Please select...
Yes
No
Please describe the purpose a loan would be for your business (e.g., "I want to purchase a box truck.")
Has your business been bonded?
Please select...
Yes
No
What are the biggest challenges facing your business?
What is a recent credit score:
What are your current short-term and long-term goals for your business?
What specific contracts or projects are you hoping to secure in the near future?
Anything else you would like to share about your business:
T
o protect your data, ECDI uses multiple safeguards including multi-factor authentication, server backups, best in class endpoint detection and response software to ensure your information is safe.