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
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
