SMALL BUSINESS INFORMATION FORM
Community Law Center

Instructions:  Please answer every question as completely and fully as possible 
and attach all requested documents.  Failure to answer all questions may result in 
delayed processing. 

Date:					

Name of Business: 


Business Address:


Telephone:					E-mail:

Fax:						Website:	

Please list ALL owners, operators, members, and/or partners.
(*List the primary contact first.)                      		
Name			      
Street Address                                     
Phone			
E-Mail	
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Please give a brief description of the business.  
(Attach business plan and any promotional materials)
                                                                                                                                                                               

                                                                                                                                                                               

                                                                                                                                                                               

                                                                                                                                                                               

                                                                                                                                                                               

(In addition to answering the following, please attach copies of all organizational documents, 
including the letter from the State Department of Assessments and Taxation recognizing the 
business)



The business currently operates as a (Please check one):
  sole proprietorship	   partnership   	corporation   
  limited liability company/partnership 		 other(please specify)

Was the organization created and registered in Maryland?  Yes/No 

How long has the organization been in existence?_____________.  


FINANCIAL INFORMATION
What are your funding sources?


What is your fiscal year? 	


Amount budgeted annually for legal expenses:



LEGAL ISSUE 
(Please attach additional pages if necessary)
What are the specific issues for which you need the assistance of the Community Law Center?




Have you received help from any other organization or lawyer on this issue?  If so, please list 
names of organizations and/or lawyers, attaching additional pages if necessary.



Attach any documents that relate to this issue and any documents that you believe an attorney 
needs to review in order to help you.	

How did you hear about us?                                                                                                           


Please answer all questions, attach requested documents and return to:
Community Law Center, Inc
3355 Keswick Road, Suite 200
Baltimore MD 21211					
Phone: (410) 366 - 0922   
Fax: 410-366-7763

Internal use only