5x5x5 Application Form Step 1 of 5 20% Contact Information Name * Email * Phone * Business Title Legal Business Name DBA Principal Office Address Street Address Address Line 2 city ZIP / Postal Code Country... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russian Federation Rwanda Réunion Saint Barthélémy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka State of Palestine Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria São Tomé and Príncipe Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu USA Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (USA) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country -- Select State -- Aveiro Hokkaidō Aomori Beja Iwate Braga Bragança Miyagi Castelo Branco Akita Yamagata Coimbra Fukushima Évora Ibaraki Faro Tochigi Guarda Gunma Leiria Saitama Lisboa Chiba Portalegre Porto Tōkyō Kanagawa Santarém Setúbal Niigata Toyama Viana do Castelo Vila Real Ishikawa Fukui Viseu Yamanashi Açores Nagano Gifu Shizuoka Aichi Mie Shiga Kyōto Ōsaka Hyōgo Nara Wakayama Madeira Tottori Shimane Okayama Hiroshima Yamaguchi Tokushima Kagawa Ehime Kōchi Fukuoka Saga Nagasaki Kumamoto Ōita Miyazaki Kagoshima Okinawa Salta Alacant (Alicante) Armed Forces Americas Albacete Alberta Acre Aceh Australian Capital Territory Republic of Adygeya Armed Forces Europe Agrigento Aguascalientes Ajman Alaska Alagoas Altai Republic Almería Alessandria Alabama Altai Krai Alexandria Amazonas Amazonas Amur Oblast Ancona Andaman and Nicobar Antioquia Aosta Andhra Pradesh Amapá Armed Forces Pacific Ascoli Piceno L'Aquila Arezzo Arkansas Arunachal Pradesh Arauca Arkhangelsk Oblast Assam American Samoa Aswan Astrakhan Oblast Asyut Asti Atlántico Auckland Ávila Avellino Alta Verapaz Arizona Abu Dhabi Barcelona Buenos Aires Red Sea Bali Republic of Bashkortostan Bari Bahia Badajoz Bangka Belitung British Columbia Baja California Baja California Sur Bengkulu Belgorod Oblast Bergamo Beheira Bizkaia (Vizcaya) Biella Belluno Benevento Beni Suef Bologna Bolívar Bay of Plenty Boyacá Brindisi Bihar Bryansk Oblast Brescia Barletta-Andria-Trani Banten Burgos Republic of Buryatia Baja Verapaz Bolzano A Coruña (La Coruña) Cairo Ciudad Autónoma de Buenos Aires Cagliari California Cádiz Caldas Campeche Canterbury Caquetá Casanare Cauca Campobasso Cáceres Caserta Ceuta Ceará Chechen Republic Cesar Chattisgarh Chieti Chandigarh Chelyabinsk Oblast Chihuahua Chocó Chiapas Chukotka Autonomous Okrug Carbonia-Iglesias Caltanissetta Chimaltenango Cuneo Córdoba Como Colorado Coahuila Colima Córdoba Chiquimula Cremona Ciudad Real Castelló (Castellón) Cosenza Connecticut Catania Chuvash Republic Cuenca Cundinamarca Catanzaro San Luis Republic of Dagestan District of Columbia D.C. Daman and Diu Delaware Distrito Federal Ciudad de México Dakahlia Delhi Dadra and Nagar Haveli Damietta Dubai Durango Entre Ríos Eastern Cape Enna El Progreso Espírito Santo Escuintla La Rioja Forlì-Cesena Ferrara Foggia Firenze Florida Federated States of Micronesia Fermo Frosinone Free State Fujairah Faiyum Santiago Del Estero Georgia Goa Las Palmas Genova Gharbia Girona (Gerona) Gisborne Gujarat Gorizia Gorontalo Goiás Grosseto Granada Guerrero Gauteng Guam Guadalajara Guatemala Guanajuato Guainía Guaviare Giza Huelva Chaco Hawaii Hidalgo Hawke's Bay Himachal Pradesh Haryana Helwan Huesca Huehuetenango Huila Iowa Idaho Illinois Imperia Republic of Ingushetia Indiana Irkutsk Oblast Ismailia Isernia Ivanovo Oblast Izabal Jaén San Juan Jambi Jalisco Jalapa Jawa Barat Jharkhand Johor Jawa Timur Jammu and Kashmir Jakarta South Sinai Jawa Tengah Jutiapa Catamarca Karnataka Kamchatka Krai Kalimantan Barat Qalyubia Kabardino-Balkarian Republic Karachay–Cherkess Republic Krasnodar Krai Kedah Kemerovo Oblast Kafr el-Sheikh Kaliningrad Oblast Kurgan Oblast Khabarovsk Krai Khanty-Mansi Autonomous Okrug Kalimantan Timur Kirov Oblast Republic of Khakassia Republic of Kalmykia Kerala Kaluga Oblast Qena Komi Republic Kostroma Oblast Crotone Republic of Karelia Kepulauan Riau Kursk Oblast Kalimantan Selatan Kansas Kalimantan Tengah Kelantan Kalimantan Utara Kuala Lumpur Kentucky Krasnoyarsk Krai La Pampa Lleida (Lérida) Louisiana Lampung La Guajira Labuan Lecco Lakshadweep Lecce León Leningrad Oblast Livorno Lipetsk Oblast La Rioja Lodi Limpopo Latina Lugo Lucca Luxor Madrid Mendoza Massachusetts Málaga Maranhão Maluku Magdalena Magadan Oblast Manitoba Monza e Brianza Marlborough Macerata Maryland Melilla Maine Mari El Republic Messina Meta México Minas Gerais Maharashtra Marshall Islands Milano Michigan Michoacán Meghalaya Melaka Minya Minnesota Manipur Mantova Monufia Republic of Mordovia Missouri Modena Morelos Moscow Oblast Moscow Mpumalanga Madhya Pradesh Northern Mariana Islands Massa-Carrara Mississippi Mato Grosso do Sul Montana Matera Mato Grosso Matrouh Maluku Utara Murcia Murmansk Oblast Manawatu-Wanganui Mizoram Misiones Navarra (Nafarroa) Napoli Nariño Nayarit Nusa Tenggara Barat New Brunswick Northern Cape North Carolina North Dakota Nebraska Novgorod Oblast New Hampshire Nizhny Novgorod Oblast New Jersey Nagaland Newfoundland and Labrador KwaZulu-Natal Nuevo León New Mexico Novara Nova Scotia Norte de Santander Nelson Negeri Sembilan New South Wales Nusa Tenggara Timur Northwest Territories Northern Territory Northland Nunavut Nuoro Nevada Novosibirsk Oblast North West New York Asturias Oaxaca Ogliastra Ohio Oklahoma Omsk Oblast Ontario Oregon Orissa Ourense (Orense) Oristano Orenburg Oblast Oryol Oblast Olbia-Tempio Otago Formosa Palencia Palermo Papua Pennsylvania Pará Punjab Paraíba Papua Barat Piacenza Padova Pernambuco Pescara Prince Edward Island Perm Krai Petén Perugia Pahang Piauí Pisa Putrajaya Perlis Illes Balears (Islas Baleares) Pordenone Pulau Pinang Penza Oblast Pontevedra Prato Puerto Rico Parma Paraná Primorsky Krai Perak Pskov Oblast Pistoia Port Said Pesaro e Urbino Puebla Putumayo Pavia Palau Puducherry Potenza Neuquén Quebec Queensland Quetzaltenango Querétaro Quiché Quindio Río Negro Ravenna Reggio Calabria Reggio Emilia Retalhuleu Ragusa Rieti Rhode Island Riau Risaralda Rio de Janeiro Rajasthan Ras al-Khaimah Roma Rimini Rio Grande do Norte Rovigo Rondônia Quintana Roo Rostov Oblast Roraima Rio Grande do Sul Ryazan Oblast Cantabria Santa Fe Salamanca Salerno South Australia Sakha Republic (Yakutia) Sulawesi Utara Sacatepéquez Sakhalin Oblast Samara Oblast Santander Archipiélago de San Andrés, Providencia y Santa Catalina Saratov Oblast Sumatra Barat Sabah South Carolina Santa Catarina South Dakota Sergipe Republic of North Ossetia–Alania Sevilla Segovia Sulawesi Tenggara Selangor Sharjah Sohag Al Sharqia Siena Sinaloa North Sinai Saskatchewan Sikkim San Luis Potosí San Marcos Smolensk Oblast Sulawesi Selatan Sondrio Soria Sololá Sonora La Spezia São Paulo Saint Petersburg Sulawesi Barat Siracusa Santa Rosa Gipuzkoa (Guipúzcoa) Sumatra Selatan Sassari Sulawesi Tengah Stavropol Krai Southland Sumatra Utara Sud Sardegna 6th of October Suchitepéquez Sucre Suez Savona Sverdlovsk Oblast Sarawak Tucumán Tarragona Taranto Republic of Tatarstan Tabasco Tambov Oblast Tamaulipas Tasmania Tasman Teramo Teruel Santa Cruz de Tenerife Taranaki Tlaxcala Tennessee Trento Tamil Nadu Toledo Torino Tocantins Tolima Tomsk Oblast Totonicapán Trapani Tripura Terni Terengganu Telangana Trieste Tula Oblast Treviso Tver Oblast Texas Tyva Republic Tyumen Oblast Chobut Udmurtia Udine Uttarakhand Ulyanovsk Oblast Uttar Pradesh Umm al-Quwain Utah Tierra del Fuego València (Valencia) Virginia Valladolid Varese Valle del Cauca Vaupés Verbano-Cusio-Ossola Vercelli Venezia Veracruz Volgograd Oblast Araba/Álava Virgin Islands Vicenza Victoria Vichada Vladimir Oblast Vologda Oblast Voronezh Oblast Verona Medio Campidano Viterbo Vermont Vibo Valentia Corrientes Western Australia Washington New Valley West Bengal Western Cape Wellington Wisconsin Waikato West Coast West Virginia Wyoming Córdoba Jujuy Yamalo-Nenets Autonomous Okrug Yaroslavl Oblast Jewish Autonomous Oblast Yogyakarta Yukon Yucatán Santa Cruz Zaragoza Zamora Zacapa Zacatecas STATE / PROVINCE / REGION Mailing Address is same as principle office Mailing Address Street Address Address Line 2 city ZIP / Postal Code Country... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russian Federation Rwanda Réunion Saint Barthélémy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka State of Palestine Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria São Tomé and Príncipe Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu USA Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (USA) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country -- Select State -- Aveiro Hokkaidō Aomori Beja Iwate Braga Bragança Miyagi Castelo Branco Akita Yamagata Coimbra Fukushima Évora Ibaraki Faro Tochigi Guarda Gunma Leiria Saitama Lisboa Chiba Portalegre Porto Tōkyō Kanagawa Santarém Setúbal Niigata Toyama Viana do Castelo Vila Real Ishikawa Fukui Viseu Yamanashi Açores Nagano Gifu Shizuoka Aichi Mie Shiga Kyōto Ōsaka Hyōgo Nara Wakayama Madeira Tottori Shimane Okayama Hiroshima Yamaguchi Tokushima Kagawa Ehime Kōchi Fukuoka Saga Nagasaki Kumamoto Ōita Miyazaki Kagoshima Okinawa Salta Alacant (Alicante) Armed Forces Americas Albacete Alberta Acre Aceh Australian Capital Territory Republic of Adygeya Armed Forces Europe Agrigento Aguascalientes Ajman Alaska Alagoas Altai Republic Almería Alessandria Alabama Altai Krai Alexandria Amazonas Amazonas Amur Oblast Ancona Andaman and Nicobar Antioquia Aosta Andhra Pradesh Amapá Armed Forces Pacific Ascoli Piceno L'Aquila Arezzo Arkansas Arunachal Pradesh Arauca Arkhangelsk Oblast Assam American Samoa Aswan Astrakhan Oblast Asyut Asti Atlántico Auckland Ávila Avellino Alta Verapaz Arizona Abu Dhabi Barcelona Buenos Aires Red Sea Bali Republic of Bashkortostan Bari Bahia Badajoz Bangka Belitung British Columbia Baja California Baja California Sur Bengkulu Belgorod Oblast Bergamo Beheira Bizkaia (Vizcaya) Biella Belluno Benevento Beni Suef Bologna Bolívar Bay of Plenty Boyacá Brindisi Bihar Bryansk Oblast Brescia Barletta-Andria-Trani Banten Burgos Republic of Buryatia Baja Verapaz Bolzano A Coruña (La Coruña) Cairo Ciudad Autónoma de Buenos Aires Cagliari California Cádiz Caldas Campeche Canterbury Caquetá Casanare Cauca Campobasso Cáceres Caserta Ceuta Ceará Chechen Republic Cesar Chattisgarh Chieti Chandigarh Chelyabinsk Oblast Chihuahua Chocó Chiapas Chukotka Autonomous Okrug Carbonia-Iglesias Caltanissetta Chimaltenango Cuneo Córdoba Como Colorado Coahuila Colima Córdoba Chiquimula Cremona Ciudad Real Castelló (Castellón) Cosenza Connecticut Catania Chuvash Republic Cuenca Cundinamarca Catanzaro San Luis Republic of Dagestan District of Columbia D.C. Daman and Diu Delaware Distrito Federal Ciudad de México Dakahlia Delhi Dadra and Nagar Haveli Damietta Dubai Durango Entre Ríos Eastern Cape Enna El Progreso Espírito Santo Escuintla La Rioja Forlì-Cesena Ferrara Foggia Firenze Florida Federated States of Micronesia Fermo Frosinone Free State Fujairah Faiyum Santiago Del Estero Georgia Goa Las Palmas Genova Gharbia Girona (Gerona) Gisborne Gujarat Gorizia Gorontalo Goiás Grosseto Granada Guerrero Gauteng Guam Guadalajara Guatemala Guanajuato Guainía Guaviare Giza Huelva Chaco Hawaii Hidalgo Hawke's Bay Himachal Pradesh Haryana Helwan Huesca Huehuetenango Huila Iowa Idaho Illinois Imperia Republic of Ingushetia Indiana Irkutsk Oblast Ismailia Isernia Ivanovo Oblast Izabal Jaén San Juan Jambi Jalisco Jalapa Jawa Barat Jharkhand Johor Jawa Timur Jammu and Kashmir Jakarta South Sinai Jawa Tengah Jutiapa Catamarca Karnataka Kamchatka Krai Kalimantan Barat Qalyubia Kabardino-Balkarian Republic Karachay–Cherkess Republic Krasnodar Krai Kedah Kemerovo Oblast Kafr el-Sheikh Kaliningrad Oblast Kurgan Oblast Khabarovsk Krai Khanty-Mansi Autonomous Okrug Kalimantan Timur Kirov Oblast Republic of Khakassia Republic of Kalmykia Kerala Kaluga Oblast Qena Komi Republic Kostroma Oblast Crotone Republic of Karelia Kepulauan Riau Kursk Oblast Kalimantan Selatan Kansas Kalimantan Tengah Kelantan Kalimantan Utara Kuala Lumpur Kentucky Krasnoyarsk Krai La Pampa Lleida (Lérida) Louisiana Lampung La Guajira Labuan Lecco Lakshadweep Lecce León Leningrad Oblast Livorno Lipetsk Oblast La Rioja Lodi Limpopo Latina Lugo Lucca Luxor Madrid Mendoza Massachusetts Málaga Maranhão Maluku Magdalena Magadan Oblast Manitoba Monza e Brianza Marlborough Macerata Maryland Melilla Maine Mari El Republic Messina Meta México Minas Gerais Maharashtra Marshall Islands Milano Michigan Michoacán Meghalaya Melaka Minya Minnesota Manipur Mantova Monufia Republic of Mordovia Missouri Modena Morelos Moscow Oblast Moscow Mpumalanga Madhya Pradesh Northern Mariana Islands Massa-Carrara Mississippi Mato Grosso do Sul Montana Matera Mato Grosso Matrouh Maluku Utara Murcia Murmansk Oblast Manawatu-Wanganui Mizoram Misiones Navarra (Nafarroa) Napoli Nariño Nayarit Nusa Tenggara Barat New Brunswick Northern Cape North Carolina North Dakota Nebraska Novgorod Oblast New Hampshire Nizhny Novgorod Oblast New Jersey Nagaland Newfoundland and Labrador KwaZulu-Natal Nuevo León New Mexico Novara Nova Scotia Norte de Santander Nelson Negeri Sembilan New South Wales Nusa Tenggara Timur Northwest Territories Northern Territory Northland Nunavut Nuoro Nevada Novosibirsk Oblast North West New York Asturias Oaxaca Ogliastra Ohio Oklahoma Omsk Oblast Ontario Oregon Orissa Ourense (Orense) Oristano Orenburg Oblast Oryol Oblast Olbia-Tempio Otago Formosa Palencia Palermo Papua Pennsylvania Pará Punjab Paraíba Papua Barat Piacenza Padova Pernambuco Pescara Prince Edward Island Perm Krai Petén Perugia Pahang Piauí Pisa Putrajaya Perlis Illes Balears (Islas Baleares) Pordenone Pulau Pinang Penza Oblast Pontevedra Prato Puerto Rico Parma Paraná Primorsky Krai Perak Pskov Oblast Pistoia Port Said Pesaro e Urbino Puebla Putumayo Pavia Palau Puducherry Potenza Neuquén Quebec Queensland Quetzaltenango Querétaro Quiché Quindio Río Negro Ravenna Reggio Calabria Reggio Emilia Retalhuleu Ragusa Rieti Rhode Island Riau Risaralda Rio de Janeiro Rajasthan Ras al-Khaimah Roma Rimini Rio Grande do Norte Rovigo Rondônia Quintana Roo Rostov Oblast Roraima Rio Grande do Sul Ryazan Oblast Cantabria Santa Fe Salamanca Salerno South Australia Sakha Republic (Yakutia) Sulawesi Utara Sacatepéquez Sakhalin Oblast Samara Oblast Santander Archipiélago de San Andrés, Providencia y Santa Catalina Saratov Oblast Sumatra Barat Sabah South Carolina Santa Catarina South Dakota Sergipe Republic of North Ossetia–Alania Sevilla Segovia Sulawesi Tenggara Selangor Sharjah Sohag Al Sharqia Siena Sinaloa North Sinai Saskatchewan Sikkim San Luis Potosí San Marcos Smolensk Oblast Sulawesi Selatan Sondrio Soria Sololá Sonora La Spezia São Paulo Saint Petersburg Sulawesi Barat Siracusa Santa Rosa Gipuzkoa (Guipúzcoa) Sumatra Selatan Sassari Sulawesi Tengah Stavropol Krai Southland Sumatra Utara Sud Sardegna 6th of October Suchitepéquez Sucre Suez Savona Sverdlovsk Oblast Sarawak Tucumán Tarragona Taranto Republic of Tatarstan Tabasco Tambov Oblast Tamaulipas Tasmania Tasman Teramo Teruel Santa Cruz de Tenerife Taranaki Tlaxcala Tennessee Trento Tamil Nadu Toledo Torino Tocantins Tolima Tomsk Oblast Totonicapán Trapani Tripura Terni Terengganu Telangana Trieste Tula Oblast Treviso Tver Oblast Texas Tyva Republic Tyumen Oblast Chobut Udmurtia Udine Uttarakhand Ulyanovsk Oblast Uttar Pradesh Umm al-Quwain Utah Tierra del Fuego València (Valencia) Virginia Valladolid Varese Valle del Cauca Vaupés Verbano-Cusio-Ossola Vercelli Venezia Veracruz Volgograd Oblast Araba/Álava Virgin Islands Vicenza Victoria Vichada Vladimir Oblast Vologda Oblast Voronezh Oblast Verona Medio Campidano Viterbo Vermont Vibo Valentia Corrientes Western Australia Washington New Valley West Bengal Western Cape Wellington Wisconsin Waikato West Coast West Virginia Wyoming Córdoba Jujuy Yamalo-Nenets Autonomous Okrug Yaroslavl Oblast Jewish Autonomous Oblast Yogyakarta Yukon Yucatán Santa Cruz Zaragoza Zamora Zacapa Zacatecas Is your business 51% or more owned by women? Yes No Save and Continue Step 2 of 5 40% Founder Information ( Owner ) Name * Email * Business Title Percentage of Ownership Do any of the following apply to you? I identify as a woman entrepreneur or as an aspiring woman entrepreneur My venture does or could qualify as a Women Business Enterprise My venture does or could qualify as a Minority Business Enterprise I identify as LGBTQ+ I am a veteran or active duty military personnel I identify as a person with a disability and/or handicap I choose not to answer Other Racial Identity Alaska Native Asian or Asian American Black or African American Hispanic or Latino Indigenous American Middle Eastern or North African Native Hawaiian or Other Pacific Islander White or Caucasian Other Prefer Not to Answer Age Under 25 25-35 36-49 50-64 65+ Prefer not to answer Time Commitment within Business This owner works 40+ hours per week in the business. This owner works 10-25 hours per week in the business. This owner works less than 10 hours per week in the business. This owner does not work in the business. Add another Founder? Yes No Previous Save and Continue Skip Step 3 of 5 60% Business Information Indicate your Business Type Sole Propriator S Corporation C Corporation Limited Liability Company None of the Above Year Business Incorporated -- Select Year -- Employer Identification Number Which of the following categories best describes what your business does? Accomodations Constructions Finance Food Service Health Care Insurance Manufacturing Real Estate Rental and Leasing Retail Social Assistance Transportation Warehouse Whole Sale Education (K-12) Higher Education Government Other or Unsure How many current part- and full-time employees does your business have? 0 1 - 4 5 - 9 10 - 24 25 - 29 100+ What type of Ownership Agreement do you have in place with your co-founder(s)? Operations Agreement Shareholder Agreement Partnership Agreement None Not applicable to my business How much revenue did your business generate in the last fiscal year? 500 character(s) left. Did you generate profit in your last fiscal year? Yes No Previous Save and Continue Step 4 of 5 80% Past Funding Summary of Funding Sources to Date ? Personal funds provided by founder(s) Grant(s) Gift from friends, family, colleagues Loan from friends, family, colleagues Loan from fiscal institution Investor Amount secured from funders to date Funding Goal and Request How much funding are you currently raising total? What other types of funding are you raising? Grant(s) Gift from friends, family, colleagues Loan from friends, family, colleagues Loan from fiscal institution Investor Previous Save and Continue Step 5 of 5 100% Business Model and Growth What is the current status of your business? I am evaluating a business idea for viability I launched my business but have not made any sales yet I am running my business and started making sales within the last 12 months I have been running my business and making sales for more than 12 months What problem and/or opportunity does your business address? 500 character(s) left. Who is your initial or primary target market? 500 character(s) left. What is the product or service your business provides? 500 character(s) left. Who are your competitors? 500 character(s) left. How is your business innovative within its industry? 500 character(s) left. What are your primary revenue streams? 500 character(s) left. What are your major expenses? 500 character(s) left. What accomplishments have you made within your business to date? 500 character(s) left. What is your plan to scale to a national market? 500 character(s) left. What are your major milestones for the next 12 months? 500 character(s) left. How will the $5,000 grant impact your business? 500 character(s) left. Budget for use of the $5,000 grant? 500 character(s) left. Terms and Conditions I Agree to the Terms and Conditions of Doyenne. Previous Submit