Empowerment Form Name * First Name Last Name Phone (###) ### #### WhatsAPP Number (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country What business are you into? Services Buying and Selling Logistics Contracts Is your business currently registered with CAC? Yes No What Date Did you start your business? MM DD YYYY Do you have a current proposal? Yes No What type of business are you into? * What is your current budget? How did you hear about us? Facebook Instagram X Threads Linkedln Youtube Are you following us on all the social media? Yes No Could you please explain how you plan to use the 100K and pay it back before the deadline? * Thank you!
