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Initial Intake Form

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* 1. Please provide your personal contact information below

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* 2. Please provide your business contact information

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* 3. Business Start Date

Date

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

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* 5. Do you have a business website?

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* 6. Number of Employees (including owner)

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* 7. What is the Business Structure

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* 8. What is the size of your Household?

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* 9. Please indicate your household income.

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* 10. How did you hear about this program?

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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:

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