NonSubstantive Change for Business Client Engagement For

Minority Business Development Agency Business Center Program Services
Business Center Internal/External Client Engagement Form
The U.S. Department of Commerce Minority Business Development Agency’s (MBDA) mission is to foster
the growth and global competitiveness of minority business enterprises (MBEs). MBDA accomplishes its
mission by funding and working cooperatively with Business Centers that assist clients that are socially
or economically disadvantaged, regardless of race or ethnicity, by facilitating transactions through
referrals, business consulting, contract bid/proposal preparation, loan packaging, and/or matching
contract opportunities and capital sources (i.e., loans, equity, bonding, etc.). In addition, Business
Centers help clients to achieve their growth objectives by connecting them with prospective strategic
partners through business-to-business matching, teaming arrangements, joint ventures, or other
strategic advisory services.
Acknowledgement of Client Relationship
(“client”) has engaged with the
Business
Center (“Business Center”) for business consulting or other services. The services provided by
Business Center to the client are subsidized through Federal appropriations. MBDA-funded Business
Center agrees to provide one or more of the following services:
business match-making
business consulting
contract opportunity sourcing
capital sourcing
other services (describe)
.
MBDA does not guarantee any particular outcome or business result on behalf of the client or
associated third parties and is not liable for any outcomes or business decisions made by the client or
associated third parties.
Acceptance of Client Relationship
The client agrees to: (a) acknowledge the relationship with Business Center (as demonstrated in this
agreement); (b) provide firm contact and profile information; (c) disclose to MBDA and/or Business Center
outcome(s) based on the services provided to the client by Business Center to MBDA; and (d) provide
documentary verification to MBDA and/or Business Center for transactions resulting from services
provided pursuant to this engagement.
Certification
Under this agreement, the client certifies under penalty of perjury that it is a minority business
enterprise (MBE), as defined by the MBDA Act. 15 U.S.C. §§ 9501(9), (15). A minority business
enterprise (MBE) under the MBDA Act is a business enterprise majority-owned and controlled by at
least one socially or economically disadvantaged individual. 15 U.S.C. § 9501(9). A socially
disadvantaged individual is an individual who has been subjected to racial or ethnic prejudice or cultural

bias because of the identity of the individual as a member of a group, without regard to any individual
quality of the individual that is unrelated to that identity. 15 U.S.C. § 9501(15). An economically
disadvantaged individual is an individual whose ability to compete in the free enterprise system been
impaired due to diminished capital and credit opportunities, as compared to others in the same line of
business and competitive market areas, because of the identity of the individual as a member of a
group, without regard to any individual quality of the individual that is unrelated to that identity. 15
U.S.C. § 9501(15). An individual of any race or ethnicity may meet the definition of socially or
economically disadvantaged under the MBDA Act.
Privacy Disclosure and Information Use
By submitting this form, your company agrees to allow the Business Center and/or MBDA to share this
document, information contained therein, and any supplementary material provided by your
company (collectively “Client Engagement Form”) on an as needed basis, with United States
Government agencies to carry out appropriate due diligence and more effectively advocate for your
interests. The Client Engagement Form also may be used by MBDA and Business Centers for the
purposes of conducting research, studies, and analysis consistent with the MBDA mission as stated in
the MBDA Act. The Client Engagement Form is considered business confidential and will not be
shared with any other person or organization outside the U.S. Government unless MBDA is given
permission to do so by your company. All business confidential information will be protected from
disclosure to the extent permitted by law.

Signature of Authorized Client Representative

Print Name of Authorized Client Representative

Name of Business

Address

(Date)

City, State, Zip
Telephone
E-Mail

For Internal Use Only
Business Center Location:
MBDA Business Center Staff:
Interview Date:
MBDA Staff Referral Name:
Referral Date:

CRM Certified Date: