For all of the following questions, please answer regarding the existing or planned business for which you seek assistance.
Enter your 5 digit Zip Code. If you don't have one or don't know your zip code, enter 00000
Leave blank if you do not have a name chosen or the business name is the same as your name.
Your position or title related to this business
Your physical street address (number and street) of the business. If a home based business, or the business has not started yet, use your home address.
Optional. Use if you need additional address postal information like apt, floor, suite, etc., or a PO box.
Please enter contact information regarding this business so that we may contact you if necessary
The best phone number (with area code) to reach you during our standard business hours. Include extension if necessary.
Type of the primary phone above
A secondary phone number to contact you, if we cannot reach you at the primary number.
Type of the secondary phone above
Web site URL for the business
Brief three to five word description of the business
Please answer the following demographic questions about yourself.
Check any that apply
Do you consider yourself a person with a disability
Check if you have started conducting business. Leave unchecked if you are in the planning stages and have yet to start this business.
Since this business has started, please enter the following information.
Year this business started
Month this business started
Primary category of business
Enter the percent female ownership for this business.
If business is home based
If you are currently 8(a) certified.
Legal entity of the business
Current Number of Full Time Employees
Current Number of Part Time Employees
Annual Sales $ for the most recent full business year
Annual Profit/Loss $ for the most recent full business year
Current Number of Total Export Related Employees
Export Related Sales for most recent full business year
Countries you are currently exporting to.
Start typing the name of the country and a list will appear to choose from. You may select more than one.
Check all the kinds of assistance that you seek
Please read the following, enter your Full Name, and click Continue below to indicate your acceptance.
I request business counseling service from the Small Business Administration (SBA) or an SBA Resource Partner. I agree to cooperate should I be selected to participate in surveys designed to evaluate SBA services. The check box below is optional. You do not need to agree to share your contact information with SBA to receive service.
I understand that any information disclosed will be held in strict confidence. (SBA will not provide your personal information to commercial entities.) I authorize SBA 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 SBA personnel, and that of its Resource Partners 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.
Please enter your full name, indicating your acceptance of the above terms.
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