An Opportunityto invest BFF 2.0 Investor Application Hello food actors! Please take a moment to complete this intake form which will be reviewed periodically. A member of the due diligence will reach out to you within X weeks. Thank you for your time. Date CONTACT INFO First Name Last Name Role Business Name Phone Number Work Email Personal Email Do you identify as BI-POC? (Black, Indigenous, or a Person of Color)YesNoI prefer not to say Do you identify as Black? (African-American, African, or Afro-Latinx, Afro-Caribbean, multi-racial with African ancestry, etc.)YesNoI prefer not to say BUSINESS CONTACT INFO Name of Business/Enterprise Business Email Business Phone Number Business Website Business Street Address Business City Business StatePlease select... AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Business Zip Code BUSINESS BACKGROUND INFO Where are you based? (Please note: Black Farmer Fund provides funding in the Northeast in the following states: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New York, New Jersey, Pennsylvania)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 Other Black Farmer Fund provides funding in the following states: (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New York, New Jersey, Pennsylvania)I conduct my business in one of these statesI do not conduct my business in one of these statesOther Business Focus Social ImpactClimate changeGender Decreasing and mitigating carbon and water footprint Underserved communityManaging wasteSourcing renewable energyCreating economic opportunities for BIPOC workers by doing any of the following (examples: just pay scale, ownership stake, fair wage, benefits, professional development)Sourcing portions of supply chain locallyCreating products and provides services that create positive health outcomes Use of FundsOperations/working capitalLand acquisitionInfrastructure DevelopmentRaw MaterialsEquipmentPersonal/Business DebtsOther Black Farmer Fund’s mission is to nurture and grow community wealth and health by investing in black agriculture across the Northeast. What excites you about this mission? Years in Operation0 - 2 years3 - 4 years5 - 10 years10+ years Have you previously applied for funding from Black Farmer Fund?YesNo Annual RevenueI don't have any revenue / $0$1 - $500$501 - $1,000$1,001 - $5,000$5,001 - $10,000$10,001 - $25,000$25,001 - $50,000$50,001 - $75,000$75,001 - $100,000+$100,000 STAYING CONNECTED Black Farmer Fund has a monthly newsletter which includes updates, activities and funding opportunities. I would like to opt into Black Farmer Fund's monthly newsletter.Yes Edit this text If yes, please confirm the email address you'd like to receive the monthly newsletter The Black Farmer Fund listserve is limited to Black food actors in the Northeast; it is an online space to share resources, ask questions and make connections! I would like to opt into Black Farmer Fund's monthly listserv. Yes If yes, please confirm the email address you'd like to receive the listserv. Thank you for your application! Please allow at least two weeks for us to review your information. If you have questions, please reach out to investment@blackfarmerfund.com. To learn more, check out Black Farmer Fund. Contact Information
