Note: Due to high volume, processing times are 2-3 days. Thank you for your patience! New Client Inquiry Form Step 1 of 3 33% Name* First Last Phone*Email* Home Address* City* State* Zip Code* Gender* Male Female Date of Birth* MM slash DD slash YYYY Referral Source. How did you hear about GROW?* Chamber of Commerce Educational Institution Emerge GROW Client/Supporter Lender Local Economic Development Organization Print Ad Radio/Television SBA SBDC SCORE Social Media (Facebook, Twitter, Instagram, etc) Web Search What type of help are you looking for?* Start-Up Assistance Business Plan Financing/Capital Managing a Business Human Resources Customer Relations Business Accounting/Budget Cash Flow Management Tax Planning Marketing/Sales Government Contracting (including certification) Franchising Buy/Sell Business Technology eCommerce Legal Issues International Trade HiddenDescribe specific assistance needed* If other services of interest, please note here. What other industry or area of interest? Demographic InformationGROW is a resource partner of the US Small Business Administration. Much of this information is required to report back about the community we serve. It is not connected to your personal information in any way.Do you consider yourself a person with a disability?* Yes No Unknown/not disclosed Veteran Status* Not Applicable Veteran On Active Duty Member of Reserve or National Guard Service Disabled Veteran Spouse of Military Member Military or Veteran Status Non-Veteran Veteran Service/Disabled Veteran Unknown/Non-Stated Race/Ethnicity*AsianBlack/African AmericanHispanicNative American/Alaska NativeNative Hawaiian/ Pacific IslanderWhiteNo Response Tax-filing status* Single Head of Household Dependents in Household*Please enter a number from 0 to 10.A dependent is defined as a child under 18 years of age Adults in Household*Please enter a number from 1 to 10.Annual Household Income* About Your BusinessAre you currently in business?* Yes No If not currently in business, what is your industry of interest?*NoneAdministrative & SupportAgriculture, Forestry, Fishing & HuntingArts, Entertainment, & RecreationConstructionDaycareEducational ServicesFinance & InsuranceFood ServicesHealthcare & Social AssistanceHospitalityInformation ServicesManufacturingNonprofitProfessional, Scientific, & Tech ServicesReal Estate & Rental & LeasingRetailTransportationWarehouseWaste Management & Remediation ServicesWhole or TradeOtherIf yes, are you currently exporting? Yes No Name of Business Type of Business Accommodations & Food services Administration & Support Agriculture, forestry, fishing, hunting Arts, entertainment and recreation Construction Educational services Finance and Insurance Health Care & Social Assistance Information Services Manufacturing Non-Profit Professional, Scientific & Tech Services Real Estate & Rental/Leasing Retail Transportation & Warehouse Waste Management & Remediation Services Wholesale or Trade Other Percent Female Ownership Business start date MM DD YYYY Do you conduct business online? Yes No Is this a home-based business? Yes No Are you 8(a) certified? Yes No Number of Employees (including yourself)Gross revenue or sales for most recent full business year* Profits or losses for most recent full business year Business Legal Entity Sole Proprietorship Corporation LLC S Corp Partnership Other legal entity If other legal entity, please list here Business Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone Number*Business Email Address* Business Website* Brief Description of Business*Anything else you'd like to share?Consent* I agree to the confidentiality & use policy belowI understand that any information disclosed will be held in strict confidence. (SBA and GROW \ will not provide your personal information to commercial entities.) I authorize 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 SBA personnel, and that of its Resource Partners and host organizations, arising from this assistance.Please add me to GROW's email list for latest news, classes & info. Yes, Please No, Thank You
