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Request for Counseling Form

Please note: The information gathered from this form is used only by Small Business Development Center staff and is NOT made public.

A. Contact information: (Required)

First Name:  
Last Name:
Address:
City:
State/Province: Zip:
Country
Website Address:
E-Mail Address:  
Phone Numbers: Example 518-555-5555    
Home: Business:
Fax: Cellular:

B. Demographic information: (Optional)

How did you hear of us?
Race:
Ethnicity:
Business Owner Gender:
Veteran Status:
Are you disabled: Yes No
Current Income Bracket:
Within the last 2 years have you ever received: (Check one only) AFOC: Yes NO TANF: Yes NO
 
C. Business information: (Required)
Currently in Business? Yes No (If no, skip to section D)
Sales Volume:  
Profit Level/yr. %of Sales:
Name of Business:
State in which business operates:
How long in business? years.
Business State:  
Business Form:
SBA Client (Past or Present):
Exporter:
Is this a Home-based Business? Yes No
Describe your business:





D. Request for counseling information: (Required)
Describe the nature of the counseling you are seeking

Best time for contact:
Best Contact Method: Home Business Email


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NYS Small Business Development Center
State University Plaza
Corporate Woods Building, 3rd Floor
Albany, NY 12246
In NY State (800) 732-SBDC
Outside NY State (518) 443-5398

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 An accredited member of the ASBDC
Partnership Program with the SBA, administered by the State University of New York. This Cooperative Agreement is partially funded by the U.S. Small Business Administration. SBA’s funding is not an endorsement of any products, opinions, or services. All SBA funded programs are extended to the public on a nondiscriminatory basis.