Individual Business Services Agreement

This form is for a Business Coach of VSEDC.

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**Please note: Radio Button, Checkboxes, and Drop-downs cannot be auto-populated, please complete these fields manually**

(PDF)Business Services Agreement LMA & LMC
Please Select Your Business Type
Please select One (ME)
Please select One (SB)
What kind of assistance are you looking for? Select all that may apply:
To verify your residency in the City of Los Angeles, please provide one of the the following:
Required Documents:
Picture ID w/ address (or)
Utility Bill
Required Documents:
Business License (or)
Utility Bill

Client Information

Prefer not to disclose.
Enter Email
Employment Status
Is you business currently open as of today's date? *

Business Information

Are you operating this business:
Are you in danger of closing your business?
Check the business registration documentation held for your business:

Permanent Positions

List all your existing permanent positions (including yourself) by name and position title: The first two lines are provided as examples only. Attached additional sheets as needed.
Are you seeking to hire additional employees?

Enter how many employees you plan to hire in each category:


Service Provider Section

Needs Assessment Complete?
Photo ID?
Proof of Residency/Business in City?
Registered in LA BAVN?
Certifications. (Check all that apply)
Certifications. (Check all that apply)