Electronic Request for Assistance
 

Electronic Request for Assistance

(To have paper forms mailed to your postal address, please contact your local office)

UW - Parkside Small Business Development Center - Request for Assistance


APPLICANT INFORMATION  

Required fields indicated with *

Salutation*
 Mr.     Ms.     Mrs.     Dr.
*
*
Business Name
*
Address2
*
*
*
*
How to contact:  
*

     OR*
 (6082631234)
 (6082631234)
 
*  
 Asian  Black  Native American/
   Alaska Native
 Native Hawaiian/
   Pacific Islander
 White  No Reply
 
*
 Yes  No  No Reply
*
 Male  Female  No Reply
*
 Yes  No  No Reply

*
*


BUSINESS INFORMATION

(Note: If you do not have a business, please select "Nascent/Not yet in business" and skip to "PRIMARY ASSISTANCE REQUESTED" below. If you currently have a business, please pick the description that best describes your business from among the following.)

*
Business Website
Business Description (50 characters)
 Conducts business online
 Is home-based
 Is 8(a) certified
NAICS (If Known)
(9999999.99)
(Numbers only-no dollar signs or commas)
(9999999.99)
  (Numbers only-no dollar signs or commas)
 Yes  No

  • If you indicated that you are in business all the information below is REQUIRED..
Business Type*
Female Ownership*
(0-100)
Business Start Date*
(mm/dd/yyyy)
Business Organization*
Number of Employees*
Full-time: Part-time:


Topic:*
 
Describe the nature of the assistance you are seeking:*
What have you done thus far to further your business and/or business idea?
 
Do you know which counselor you would like to work with? (Counselor's Name)
 

ASSISTANCE AGREEMENT

Once we receive the Request for Assistance we will promptly provide you with services that fit your needs. We have a number of excellent resources that address the issues encountered by entrepreneurs and small business owners. We also have advisors who meet with owners of established businesses and training programs that assist entrepreneurs start and grow businesses.

I request business assistance from a SBA Resource Partner.

  • I agree to cooperate should I be selected to participate in surveys designed to evaluate SBA services.
  • I permit SBA or its agent the use of my name and address for SBA surveys.
  • I understand that any information disclosed will be held in strict confidence.
  • I authorize this SBA Resource Partner to furnish relevant information to the assigned management counselor(s).

I further understand that the counselor(s) agrees not to:

  • recommend goods or services from sources in which he/she has an interest, and
  • 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.

Please accept by typing your full name here and clicking Submit: *

 
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