If you don't have one or don't know your zip code, enter 00000 |
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Brief three to five word description of the business
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Since this business has started, please enter the following information.
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Legal entity of the business
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Current Number of Full Time Employees
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Current Number of Part Time Employees
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Annual Sales $ for the most recent full business year
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I request business counseling service from the Western Dairyland Business Center (WDBC), a resource partner of the Small Business Administration (SBA). I agree to cooperate should I be selected to participate in surveys designed to evaluate WDBC or SBA services. I permit WDBC and SBA the use of my name and address for WDBC or SBA surveys and information mailings regarding WDBC or SBA products and services. I understand that any information disclosed will be held in strict confidence. (WDBC and SBA will not provide your personal information to commercial entities.) I authorize WDBC and 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 WDBC and 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.
A program of Western Dairyland. Funded in part through a cooperative agreement with the U.S. Small Business Administration. Agreements for persons with disabilities will be made at all times in accordance with the Americans With Disabilities Act of 1990 and associated amendments. Arrangements for persons with special needs will be made if requested at least two weeks in advance. This Institution is an Equal Opportunity Provider. Language assistance services are available for limited English proficient individuals. Member of the Association of Women's Business Centers.
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