Application for services

Business Name:*

Contact Name:

Title:

Street Address:

Street Address 2:

City/State/Zip:

Email Address:*

Business Website

Business Phone:*

Business Fax:

Cell:

Lyons Business License :

Year business founded :

Type of Business :

Retail Manufacturing Service
Construction Wholesale Other

Business Structure :

C Corp
S Corp
LLC
Partnership
Sole Proprietor

Majority Owner Information:

Male     Female
Disabled    Not Disabled
Veteran      Not Veteran      Disabled Veteran

Annual Sales:

Owner Operated? :

Yes No

Are you 8(a) qualified? :

Yes No

Franchise? :

Yes No

Is there a current business plan? :

Yes No

Home Based? :

Yes No

Spanish Language Preferred?:

Yes No

No. of Employees? :

Describe the nature of your business.

Describe your business goals.

Describe current growth status of your business.

What would you like to gain from participating in the LEGG Program?

Today's Date:

Name and Title:

Name again as signature:

The Lyons Economic Gardening Group (LEGG) Program will treat all information received from applicants for assistance in a confidential manner. To the full extent allowed by law, we will not reveal any proprietary information to other businesses. We do reserve the right to create a summary list of the work we do for businesses to include in our regular reports to the Lyons Area Chamber of Commerce Board, as well as in a handout or database searches.