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Directory Questionnaire
Business Name *
Owner/Founder/Authority Name(s) *
Date *
Business Physical Address *
Mailing Address (If different from above)
Business Phone Number
Business Email
Is this business run from your home/residence?
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Do you have a website?
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If yes, Please provide the URL address
Describe your business
Is this a non-profit business?
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No
For statistical purposes, please indicate the following:
American Indian/Native American
Asian/Pacific Islander
Black/African American
Caucasian
Hispanic
Veteran Owned
Woman Owned
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