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The Build Fellowship intake form

Organization information
Representative information
First name
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Last name
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Email
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Job title
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Organization information
Trade name (DBA)
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Legal name
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Website
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LinkedIn
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Organization type
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State of registration
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Organization address
Street address
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City
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Zip code
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Signatory information
First name
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Last name
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Email
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Job title
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Financial information
Billing contact first name
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Billing contact last name
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Billing contact email
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Organization funding level
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