Established ( has generated revenue for greater than 3 years)

1. Demographic Information Which industry best describes your business? Service Food Industry Retail Wholesale Healthcare Construction Environmental Technology Research/Development Manufacturer/Producer Non Profit Other, please specify Please check all that apply to you and your business. Sole Proprietorship Family-Owned Partnership Corporation Sub S Corporation Privately-Held Publicly-Held Client Profile Form Company Name/Title Address Suite/Bldg # City/State/Zip Telephone Number Ext. E-mail Fax Number How did you hear about the MBEC _________________________________ Gender of Majority Business Ownership Male Female Male/Female Is your company a certified Woman Owned Enterprise (WBE)? Are you a Veteran Ethnicity of Majority Business Ownership Black/African American White/Caucasian Latino Asian and Pacific Islander Native American, Eskimo and Aleut Multi-racial Is your company a certified Minority Owned Enterprise (MBE)? Date Established (FEIN) - Federal Employer Identification Number (no social security numbers) What is your current business status? Start-up (has generated revenue for 3 years or less) Established ( has generated revenue for greater than 3 years) Pre-Venture What are your annual sales? How many people does your company employ? Please indicate the current number of minority employees _____________________ What are the dollar amounts of your three largest contracts (dollar amounts)? Largest Contract 2nd Largest Contract 3rd Largest Contract Please continue on the other side ... revised 1/08 Business Information Contact Information Limited Liability Please describe your product or service Other Yes Yes No No Yes No

2. MBEC Assistance — Financing MBEC Assistance — Sales and Marketing For Office Use Only Community Census Tract LI MI EZ EC If you have obtained debt financing, what amount have you received? If you have obtained equity financing, what amount have you received? If you are presently seeking financing, what amount do you need? For what purpose are you seeking financing? Personal credit score __________________ Please indicate the financing services in which you are interested. Small business loan Loan packaging Challenge grant Identification of potential equity investors Comprehensive business assessment ( review of business plan, organizational structure, competitive landscape & financial structure) Financial analysis & creation of financial plan (includes key ratios, break even analysis, assumptions) Presentation coaching (strategies for investor & client presentations) Other Does your business have a written business plan? If yes, please provide a copy when you return this form. Has it been updated in the past 6-9 months? Yes No Please indicate the sales and marketing services in which you are interested. Assistance creating or refining a sales and marketing plan Market research & analysis to identify new customers Business plan review Sales analysis & planning (sales planning, strategy development, sales implementation) A competitive analysis of your industry Other Procurement assistance Client Signature Date Financing History Yes No How is your business financed? Please check all that apply. Equity Yourself, Friends, Family Retained Earnings Angel/VC Investors Government Grants Debt Public Stock Other Commercial Bank Micro-lender Employees (Stock Ownership Plans) Personal Loan Finance Company Credit Line Insurance Company Credit Card Factoring Company Start up funds Build, renovate or expand current facility Operating (working capital) New product development Purchase new technology/equipment Research & Development Other