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IMG Consulting

Empowering Black Owned Companies With Business Evolution Solutions

Client Assessment Form

Please fill out the form below to request a free business assessment.  One of our account managers will contact you within two business days after we receive your completed form.

  • Date Format: MM slash DD slash YYYY
  • If you don't have a website enter "no current website."
  • Complete this section according to the Business Classification definitions listed by the Small Business Administration. If you are unsure of your company’s status, check the U.S. SBA website http://www.sba.gov/size for guidance. Check all that apply.
  • Enter all NAICS Codes that your company operates under. If you don't know your NAICS Codes enter 000000.
  • A minority firm must be at 51% owned, controlled, and operated on a daily basis by socially and economically disadvantaged individuals. A woman-owned firm must be at least 51% owned, controlled, and operated on a daily basis by a woman. Check all that apply.

  • Principal Owners

    If your company is minority, minority-woman, or economically disadvantaged, it is mandatory that you complete the following information for all principal officers of the company. Please list ethnicity as listed below or specify other. BA- Black American AP- Asian Pacific American HA- Hispanic American NM- Non-Minority NA- Native American SA- Subcontinent Asian American
  • Check all that apply
  • Check all that apply
  • Check all that apply
  • Check all that apply
  • Check all that apply
  • Check all that apply
  • Check all that Apply
  • Describe briefly (provide KEY information)
  • Check the areas that apply.

  • Federal Laws, Rules, And Regulations

    In accordance with Federal laws, rules, and regulations, IMG Consulting & Partners, are required to obtain the information requested in this document and the signature of a senior officer of your company. Under Chapter 15, United States Code, Section 645(d), any person who misrepresents a firm or company’s status as small business, small minority owned business, or small woman-owned business in order to obtain a contract to be awarded under programs established pursuant to Sections 8(a), 8(d), or 15 of the Small Business Act or any other provision of Federal that specifically references Section 8(d) for a definition of program eligibility shall: 1) Be punished by imposition of fine, imprisonment, or both; 2) Be subject to administrative remedies suspension and disbarment; and 3) Be ineligible for participation in programs conducted under the authority of the Act.
  • IMG Consulting reserves the right to request verification of the information contained in this profile. Please have an officer representing the company sign the completed profile.

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