Company Application (One-Time Form)
About You and Your Company
Company Name
First Name
Last Name
Phone Number
Email Address
Company Address
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
Billing Address
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
County
Weber
Other
Alternate Contact Info (Account Payable recommended, if applicable)
Alternate Contact First Name
Alternate Contact Last Name
Alternate Contact Phone Number
Alternate Contact Email Address
Company Information
Company Purpose (What does this company do (short description)?)
Are you a Non-Profit?
Yes
No
Is this your first time using Custom Fit funding?:
Yes
No
Custom Fit Objective
Please select...
Company Retention
Company Expansion
New Company in Region (less than 3 years)
US Small Business Administration Classification (optional)
Please select...
Women-Owned Small Business
Small Disadvantaged Business
Minority-Owned Business
Veteran-Owned Business
Small Business in a Historically Underutilized Business (HUB) Zone
Native American-Owned Business
LGBTQ-Owned Business
Rural Business
How did you hear about us?
Custom Fit Representative
Search Engine
Other
Your Interest in Training
What type of training is your company looking for?
I would like to receive the Custom Fit monthly newsletter.
Yes
No