LBAI - Latin Business Association Institute

PHOTO REPRESENTING THE ACCESS TO CAPITAL SECTION

ACCESS TO CAPITAL > REQUEST FOR SERVICE FORM

LOS ANGELES, CA
P (213) 628-8510
F (213) 628-8509

WELLS FARGO LOGO

UNION BANK LOGO

Download form in word format

Name:

Title:

Company:

Phone:

Fax:

Email:

Address:

City:

State:

Zip:

Type of Business:

Services	Technology
Construction	Wholesales/Retail
Manufacturing	Utilities
Finance	Insurance
Transportation	Real Estate
Public Administration	Entertainment/Advertising
Other

Date Business Established:

Certified By:

Certified With:

City of Los Angeles

County of Los Angeles

CALTRANS

Metropolitan Transportation Authority (MTA)

Geographic Market Area:
SIC Codes:
Briefly describe your products or services:

Annual Sales:

less than $99,000

$100,000 - 499,999

$500,000 - 999,999

$1,000,000 - 4,999,999

Over $5,000,000

No. Employees:

1-5

5-10

10-20

20-50

Over 50

Projected Goal of Sales for this year: $

Form of Business:

Sole Proprietor

Partnership

Corporation

Does your business accept Credit Card Payments:

Visa

American Express

Master Card

Are you a LBA member?	Yes No
Does your company have any available contract opportunities?	Yes No

IMPORTANT (Please check all that apply):
What services does your business need?
Technical Assistance Services:

	Capital Access: Loan Packing & Capital Opportunities
	Procurement Opportunities: Bid opportunities; Partnership with businesses/corporations
	Entrepreneurial Training: Starting your Business Workshops; Business Seminars; Business Planning
	Management & Business Assistance: Running a Profit Driven/Growing Business
	Certification: WBE, MBE, DBE, OBE
	M/W/OBE Sub-Contractors Referrals
	Vendor/Supplier Development Workshops
	International Trade Opportunities
	Bonding & Insurance Needs

Contracting & Procurement Services:

	City/County of Los Angeles
	Regional: Southern California
	State-wide: California
	National: United States
	International: Global Market

Partner Information:

	Latin Business Association Institute/Opportunities for Procurement & Services
	East Los Angeles Minority Business Development Center, operated by Barrio Planners, Inc.
	CHARO Business & Financial Center, operated by CHARO Industries
	Los Angeles One Stop Capital Shop, operated by MBOC
	U.S. Small Business Administration loans & services
	Workforce Development/Training provided by Hispanic Training Council

How did you hear about the LBAI?

	Friend
	Magazine/Newspaper/Media
	LBA Member
	Business
	Other Agency

The undersigned declares under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Falsification of any of the above information will cause immediate termination of services. If my business status should change, I will notify the LBAI in writing within 30 days.

Client Name: Date:

Latin Business Association Institute
5400 E. Olympic Blvd., Suite 130
Los Angeles, CA 90022
Telephone: (323) 721-4000
Fax: (213) 628-8509