Macon-Bibb Office of Small Business Affairs (OSBA) Intake Form

1. Business Name:

2. Point of Contact

3. Email

4. Business Phone

5. Business Address

6. Do you have a Macon-Bibb business license?

Yes

No

7. Are you currently certified through OSBA?

8. Are you registered with Macon-Bibb Procurement Department?

Yes

No

9. DBE Type

NAICS Code

10. What is the nature of the assistance you are seeking?

11. What type of business? (Product or Service)

12. Business Start Date

13. Do you need a business mentor?

I understand that any information disclosed will be held in strictest confidence by OSBA. I authorize OSBA to share relevant information about my request with staff and pertinent small business partners. We welcome your feedback and encourage you to call on us if you have any questions or comments during the certification process.