Full Name

Email

Phone Number

Birth Date (yyyy-mm-dd)

Gender

Place of Residence

Business Name

Business Location

Number of full time staff (including yourself)

—Please choose an option—1 to 56 to 1011 to 2021 to 5050+

What sector does your business operate in?

HealthcareAgricultureFood ProcessingEducationClean EnergyWater, sanitation & Hygiene (WASH)Other

If other, please specify

How long has your business been operating?

—Please choose an option—Less than 1 year1-3 years4-5 years6+ years

What is your business’s most recent annual revenue?

—Please choose an option—I have not made a sale so farUp to 5,000,000 TSH5,000,001 to 10,000,000 TSH10,000,001 to 20,000,000 TSH20,000,001 to 40,000,000 TSH40,000,001 to 60,000,000 TSH60,000,001 to 80,000,000 TSH80,000,001 to 100,000,000 TSHMore than 100,000,000 TSH

How would you describe your current financial situation?

—Please choose an option—I do not have enough money to run my businessI have enough money to run my business, but not enough to grow my businessI have enough money to run and grow my business

If your business has a website or Facebook page, please include a link here:

Please summarise your business here by describing your product/service, your primary customers and your goals for the business.

Have you received any other business advisory or support services?

—Please choose an option—YESNO

If yes, what type of support did you receive?

I understand that Anza charge a monthly fee of $125 (a $50 discount is applied if 4 months paid in advanced and $100 discount applied if 8 months paid in advance).
Please check this box to acknowledge

How did you hear about Anza?

Search engineSocial mediaWhatsAppSMSTanzania/Arusha MailingTangazaAnza Accelerator clientAnza team memberEventFlyer/Banner/PosterReferral from another organisationOther

If other, please specify