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Business Data
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Company Name:
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Address:
(Use your address if no business address) |
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City:
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State: |
ZIP+4:
-
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County:
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Contact Data
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Name:
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Email:
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Home Phone #:
in 999-999-9999 format |
Work Phone #: in
999-999-9999 format |
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Fax Phone #: in
999-999-9999 format |
Mobile Phone #: in
999-999-9999 format |
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BUSINESS INFORMATION
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BUSINESS OWNERSHIP
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Type of Business:
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Race:
Ethnicity:
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Large Business: (check
box if yes) |
Gender: |
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Have you ever been an SBA client:
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Military Status: |
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Company Web Site: |
Start-Up Date: (estimate if in future) |
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Within the last 2 years, have you received:
Aid to
Families with Dependent Children (AFDC)
Temporary
Assistance to Needy Families (TANF)
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Select Your Category:
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What is your question? What kind of help do you
need? Please type a description here.
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Client/Counselor Agreement
I (We) request business
management services from a Small Business Administration (SBA) partner, namely
the Small Business Development Center of South Carolina (SBDC).
I (We) understand that the counselor(s)/personnel assigned will treat
all information and data received in complete confidence.
In return for this service, I (We) agree to provide the counselor(s),
upon request, with current financial and operating data, and to satisfy such
other reasonable requests as may be made by the Small Business Development
Center of South Carolina (SBDC) during its period of service in my (our)
behalf.
I (We) understand this to be
a management and technical assistance service provided by the Small Business
Administration (SBA) partner, namely the Small Business Development Center of
South Carolina (SBDC). In
consideration of the requested service, I (We) hereby waive my (our) rights to
any and all claims arising from this service against the Small Business
Development Center of South Carolina (SBDC), its partner the Small Business
Administration (SBA), any university or college providing assistance, and/or
any personnel or counselor(s) involved in this assistance program.
I
(We) agree to cooperate should I (We) be selected to participate in surveys
designed to evaluate SBDC assistance services.
I (We) further understand that any counselor has agreed 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.
Please note: By typing
your full name and verifying it in the text boxes below you are accepting the
agreement above.
Type Your Full
Name:
Re-type For
verification:
Date:
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Form Last Updated: 8/28/2006
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