Online Application

INSTRUCTIONS:

1. Please complete the submission form below

  • Please make sure to fully and accurately complete the entire Client Application Form.
  • Financial information will be kept confidential and is used solely for the purpose of determining whether the applicant truly cannot afford legal representation.
  • When you submit an application, you allow us to share your name with our BLC Participating Attorneys in order that we may match you with an attorney.
  • BY SUBMITTING THE ONLINE APPLICATION YOU CERTIFY THAT THE INFORMATION YOU PROVIDED IS TRUE AND CORRECT, AND YOU AGREE TO THE TERMS AND CONDITIONS OF THE BLC ENGAGEMENT.

2. Please gather additional information about your business idea, including any business or strategic plans, and email to info@businesslawcorps.org

  • Applicants with business plans that will foster job creation are more likely to become BLC clients. Applicants are thus invited to submit any documentation which will help the BLC see the applicant’s business vision.
  • When emailing the BLC, please reference that you have completed our online application.

3. Applicants will be notified via email if they qualify for BLC services.

General Business Information ("*" indicates a required field)

*Business Name:

Describe your business and why it has potential:

*Status:

*Date Established:

*Total Numbers of Co-Owners/Founders/Shareholders:

*Current Number of Employees:

*Projected number of employees in 12 months:

*Projected number of employees in 3 years:

*Projected number of employees in 5 years:

What kind of project do you need help with? BLC provides assistance on a project-by-project basis, so please limit your request to one project per application:

*Have you ever worked with an attorney before on your small business?

*Has your company, or any of its founders or shareholders (including you), ever been sued?

If yes, please explain:

*Can you or your partners/shareholders afford to pay for legal services?

Point of Contact Information

*Full Name:

*Title/Role:

*Address:


,

*Email Address:

*Phone Number (Main):

Phone Number (Cell):

Applicant's Financial Need

Income

*Current monthly income: $

*Current income this year-to-date: $

*Income last year:

Expenses

Itemized Expense 1: $ for

Itemized Expense 2: $ for

Itemized Expense 3: $ for

Itemized Expense 4: $ for

*Total Monthly Expenses: $

*Current net worth (assets minus liabilities): $

Please complete the information for each co-founder/member/shareholder:

Co-Founder 1 - Name:

Income

Current monthly income: $

Current income this year-to-date: $

Income last year: $

Expenses

Total Monthly Expenses: $

Current net worth (assets minus liabilities): $

Co-Founder 2 - Name:

Income

Current monthly income: $

Current income this year-to-date: $

Income last year: $

Expenses

Total Monthly Expenses: $

Current net worth (assets minus liabilities): $

Additional information

Verification & Agreement

*Have any owners, co-founders, or shareholders been convicted of a felony?

*Have any owners, co-founders, or shareholders had any professional license revoked?*

If selected, applicant will keep the BLC updated about the progress of the business on a regular basis (this includes employee numbers)

Applicant is over eighteen years of age

I certify that the foregoing information is true and correct

Click Here to download BLC Client Application Form

BY SUBMITTING THE ONLINE APPLICATION YOU CERTIFY THAT THE INFORMATION YOU PROVIDED IS TRUE AND CORRECT, YOU AGREE TO THE TERMS AND CONDITIONS OF THE BLC ENGAGEMENT, AND YOU GIVE US PERMISSION TO SHARE YOUR NAME WITH OUR BLC PARTICIPATING ATTORNEYS SO THAT WE MAY MATCH YOU APPROPRIATELY.