Back To Meda >

 

 

 

 

 

 

Request Meda Services FormExisting Business

In order to best meet your needs as an entrepreneur, we assess your registration information and choose the resources that fit your stage of business development.  All of the information asked for below helps us do this.  Please take time to fully describe your business and your specific business needs.  Meda has a high demand for services and we work with community partners to serve you as quickly as possible. 

If your answer is zero, enter zero.  If your answer is Not Applicable, enter NA.   Registrations with blank information will not be submitted and will ask you to complete the form.  Thanks for understanding and for giving us the most complete information you have.  And, rest assured, your information is confidential and will not be shared with anyone outside Meda.  THANK YOU!

Primary Owner Information

 
Percent Owned:
 
Home Address:
City:
State:
County:
Zip:
 
 
Ethnicity:
 
Gender:
Born in U.S:
 
Gross Monthly Household Incomes: Highest Level of Education:  
Household Status:
Number in Household:
 

Company Information
Company Legal Name:
Company "Doing Business As" name:
 
County:
 
Business Phone:
 

Industry:
 
Type of Business Entity:
Business Ethnicity:
 

For Existing Businesses

   
Date Business Was Established or Acquire:
   
Annual Sales:
$
For Fiscal Year Ending:
 
Total Number of Employees:
Number of Minority Employees:
Number of Part Time Employees:
MBE & DBE Certifications:

(Hold down Ctrl key to select more than 1)
   
Registered with SAM.gov:
CAGE Code:
 
Duns Number:
Primary SIC Code(s):
Primary NAICS Codes(s):


Areas you are seeking assistance:

(Hold down Ctrl key to select more than 1)

How did you hear about Meda?:

(Hold down Ctrl key to select more than 1)

Specify how you heard about Meda :