SBDC CLIENT AGREEMENTSBDC Client Agreement • November 2nd, 2018
What we need to know about you... We may use the contact information you provide below to send you (by mail, fax, text, and/or e-mail) notices of upcoming classes and special events, and other information we feel would be beneficial to your business venture. If you do not wish to be on our contact list, please check here. Mr. Mrs. Ms. Dr. First Name: MI: Last Name: Personal Address: City: State: Zip Code: County: E-mail: Work Phone: Home Phone: Cell Phone: Gender: Female Male Race: Asian Native Hawaiian or Pacific Islander Black or African American White/Caucasian Native American or Alaskan Native Choose not to respond Ethnicity: Hispanic or Latino Non-Hispanic or Latino Choose not to respond Veteran Status: Non-Veteran Service-Disabled Veteran Veteran Choose not to respond Military Status: National Guard Reservist - Active Duty National Guard - Active Duty None Reservist Choose not to respond Do you consider yourself a person with a disability? No Yes Choose not to respond What
SBDC CLIENT AGREEMENTSBDC Client Agreement • November 2nd, 2018
What we need to know about you... We may use the contact information you provide below to send you (by mail, fax, text, and/or e-mail) notices of upcoming classes and special events, and other information we feel would be beneficial to your business venture. If you do not wish to be on our contact list, please check here. Mr. Mrs. Ms. Dr. First Name: MI: Last Name: Personal Address: City: State: Zip Code: County: E-mail: Work Phone: Home Phone: Cell Phone: Gender: Female Male Race: Asian Native Hawaiian or Pacific Islander Black or African American White/Caucasian Native American or Alaskan Native Choose not to respond Ethnicity: Hispanic or Latino Non-Hispanic or Latino Choose not to respond Veteran Status: Non-Veteran Service-Disabled Veteran Veteran Choose not to respond Military Status: National Guard Reservist - Active Duty National Guard - Active Duty None Reservist Choose not to respond Do you consider yourself a person with a disability? No Yes Choose not to respond What
SBDC CLIENT AGREEMENTSBDC Client Agreement • November 2nd, 2018
Mr. Mrs. Ms. Dr. First Name: MI: Last Name: Are you the business owner? Yes No Position/Title: Business Name (Leave blank if not in business): Address (Give business address if you are currently in business. If not in business, use personal address): City: State: Zip Code: County: Primary E-mail (Please select): Personal Business Secondary E-mail (Please select): Personal Business Primary Phone (Please select): Home Work Cell Secondary Phone (Please select): Home Work Cell Business Website: How did you hear about the Small Business Development Center? Bank/Lender EDC Social MediaSBA Federal, State or Local University Government SBDC/SBDC Workshop Internet Word of mouth PTAC Local Business SCORE/WBC Organization Chamber of Commerce Media (Newspaper, Other TV, Radio) Race: (check all that apply) Asian Black/African AmericanNative Hawaiian or Pacific Islander American Indian or Alaskan Native White Choose not to respond Ethnicity: Hispanic or LatinoNot Hispanic or Latino Choose
SBDC CLIENT AGREEMENTSBDC Client Agreement • November 2nd, 2018
What we need to know about you... Mr. Mrs. Ms. Dr. First Name: MI: Last Name: Personal Address: City: State: Zip Code: County: E-mail: Work Phone: Home Phone: Cell Phone: Gender:Female Male Race: Asian Native Hawaiian or Pacific Islander Black or African American White/Caucasian American Indian or Alaskan Native Choose not to respond Ethnicity: Hispanic or LatinoNot Hispanic or Latino Unknown Military Status:Veteran Member of the Reserves Member of the National Guard Service-Disabled Veteran On Active Duty Spouse of Military MemberUnknown/Not stated Do you consider yourself a person with a disability?No Yes What we need to know about your business, if you're already in business... Company Name: Business Phone: Business Address:(If different from Personal Address) City: State: Zip Code: County: Business E-mail: Web Site: Business Fax: Number of Employees: Full-Time: Part-Time: Is this a home- based business? No Yes For the most recent full year, what were your: Gross Revenue/Sales +Pro
SBDC CLIENT AGREEMENTSBDC Client Agreement • November 2nd, 2018
Mr. Mrs. Ms. Dr. First Name: MI: Last Name: Owner? Yes No Position/Title: Business Name (If in business): Address (Business address if currently in business): City: State: Zip Code: County: E-mail: Primary Phone (Please select): Home Work Cell Secondary Phone (Please select): Home Work Cell Web Site: How did you hear about the Small Business Development Center? Bank/Lender EDC Social MediaSBA Federal, State or Local University Government SBDC/SBDC Workshop Internet Word of mouth PTAC Local Business SCORE/WBC Organization Chamber of Commerce Media (Newspaper, Other TV, Radio) Race: Asian Black/African American Native Hawaiian or Pacific Islander American Indian or Alaskan Native White/Caucasian Choose not to respond Ethnicity: Hispanic or Latino Not Hispanic or Latino Unknown Gender:Female Male Do you consider yourself a person with a disability?No Choose not to respond Yes Military Status:None On Active Duty Spouse of Military MemberVeteran Member of the National Guard Unknown/Not
SBDC CLIENT AGREEMENTSBDC Client Agreement • November 2nd, 2018
Mr. Mrs. Ms. Dr. First Name: MI: Last Name: Are you the business owner? Yes No Position/Title: Business Name (Leave blank if not in business): Address (Give business address if you are currently in business. If not in business, use personal address): City: State: Zip Code: County: Primary E-mail (Please select): Personal Business Secondary E-mail (Please select): Personal Business Primary Phone (Please select): Home Work Cell Secondary Phone (Please select): Home Work Cell Business Website: How did you hear about the Small Business Development Center? Bank/Lender EDC Social MediaSBA Federal, State or Local University Government SBDC/SBDC Workshop Internet Word of mouth PTAC Local Business SCORE/WBC Organization Chamber of Commerce Media (Newspaper, Other TV, Radio) Race: (check all that apply) Asian Black/African AmericanNative Hawaiian or Pacific Islander American Indian or Alaskan Native White Choose not to respond Ethnicity: Hispanic or LatinoNot Hispanic or Latino Choose
