Livonia Pure Potential Small Business Program 2026 - Initial Intake

Initial Intake Form

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* 1. Please provide your personal contact information below

Full Name

Personal Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Please provide your business contact information

Legal Business Name *

DBA (if applicable)

Business Address *

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Business Email Address *

Business Phone Number *

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* 3. Business Start Date

Date / Time

Date

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* 4. Select your business type (select all that apply)

Agriculture & Forestry

Marketing, Technology and other Business Services

Construction, Utilities, Contracting Services

Childcare and Education Services

Motor Vehicle

Personal Services (personal care, entertainment, fitness, photography, cleaning, etc.)

Real Estate & Housing

Finance/Accounting, Insurance, and Taxes

Transportation

Food and Hospitality

Healthcare services

Other (please specify)

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* 5. Do you have a business website?

If Yes, please provide website URL

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* 6. Number of Employees (including owner)

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* 7. What is the Business Structure

Sole Proprietor

LLC -- Limited Liabillity Organization

Corporation

Nonprofit Organizaiton -- 501(c)3

Other (please specify)

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* 8. What is the size of your Household?

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* 9. Please indicate your household income.

$0 - $24,999

$25,000 - $34,999

$35,000 - $44,999

$45,000 - $54,999

$55,000 - $64,999

$65,000 - $72,999

$73,000 - $80,999

$81,000 - $87,999

$88,000 - $93,999

$94,000 - $100,999

$101,000 - $106,999

$107,000+

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* 10. How did you hear about this program?

City of Livonia Website

Social Media (Facebook, Twitter, X, Instagram, etc)

Partner Referral

Word of Mouth

Other (please specify)

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* 11. To be eligible for this program, your business must reside in the City of Livonia, Michigan. Please confirm your understanding of the following statements:

I confirm that my business is located in the City of Livonia, Michigan

I understand the final acceptance requires your company to be GOOD STANDING with the City of Livonia. (no outstanding fees, debts, or liens)

I agree to be contacted by the City of Livonia and/or the program team about my application