GROW Request for Counseling
 
grow business directory

Please complete this form, and the agreement on the last page, prior to receiving services from GROW.
 
Business Intake Form
*required field

Date:  
Name:*  
Address:  
City:  
State:  
Zip:  
Home Phone:  
Personal Email:*  
 
Business Name:  
Business Address:  
City:  
State:       Zip Code:  
Business Phone:  
Business Email:  
Business Web Site:  
 
Race:*  
Ethnicity:*  
Business Owner Gender:*  

Do You Consider Yourself A Person With A Disability?*		  

Gender*		  

Marital Status:*		  

When You File Your Taxes Do You File As Head of Household?*		  

Are You A Veteran?*		  

Are You A SBA Client?*		  

SBA Client Type		  

How Did You Hear About Our Programs?*		  

Describe The Nature Of Information You Are Seeking?*		  

My Annual House Income Is? (This includes everybody who lives in the home over 18.)*		  

# Adults In Home 18 and Older:*		  

# Children Under Age 18:*		  

Are You Currently in Business? (if no skip next section)*		  

Section 2

Is This A Home Based Business?		  

Type Of Business?		  

Do You Conduct Business Online?		  

Business Started On (mm/yyyy format):		  

Section 3
**WBC Addendum- Economic Impact: (This Means You Have A DBA Or Are A Registered LLC Or Corporation And Have Had Sales) Women's Business Centers are mandated under authority in the Small Business Act, Section 29(1) (3) (B), to collect specific information for measuring economic impact, so please answer the following questions:

When did you first receive assistance from a Women's Business Center? (mm/yyyy format):		  

What was your business' total sales/gross receipts last year (before taxes)?		  
If you are unsure of gross sales, please select a range:

My tax year was (yyyy)		  

What were your Profits?		  

What were your Losses? 		 

During this time how many new jobs did you create and fill (new employees for new positions)?		  

How many new jobs were eliminated (employees let go)?