If you don't have one or don't know your zip code, enter 00000 |
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Brief three to five word description of the business
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Similar to the U.S. Census Bureau, check any races that apply.
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Since this business has started, please enter the following information.
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Legal entity of the business
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Current Number of Full Time Employees
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Current Number of Part Time Employees
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Annual Sales $ for the most recent full business year
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Annual Profit/Loss $ for the most recent full business year
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I request business counseling service from the Small Business Development Center (SBDC) or Community Navigator. I agree to cooperate should I be selected to participate in surveys designed to evaluate SBDC Navigator/SBA services.
I authorize SBDC to furnish relevant information to the assigned management counselor(s). I further understand that the counselor(s) agrees not to: 1) recommend goods or services from sources in which he/she has an interest, and 2) accept fees or commissions developing from this counseling relationship. In consideration of the counselor(s) furnishing management or technical assistance, I waive all claims against SBDC/SBA personnel, and that of its Community Navigator and host organizations, arising from this assistance.
I self-certify that neither I nor my company are currently in suspension or debarment by a Federal Agency.
I permit SBA or its agent the use of my name and address for SBA surveys and information mailings regarding SBA products and services. I understand that any information disclosed will be held in strict confidence. (SBA will not provide your personal information to commercial entities.)
Please enter your full name, indicating your acceptance of the above terms.