Business Advisor Requested
Please select: First Available Business Advisor Orlando Colmenero Joe Lam Lisha Garcia Dick Johnson Mike Breck Peg Richmond Bill Thompson Paul Wright
6) Mailing Address: Street Address/PO Box, City, State & Zip Code
I request business counseling service from the Small Business Administration (SBA) or an 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 and information mailings regarding SBA products and services. I understand that any information disclosed will be held in strict confidence, said information including but not limited to confidential and proprietary information in any form whatsoever, including oral, written and machine readable form. SBA will not provide your 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. I waive all claims against SBA personnel, resource partners and host organizations, arising from this assistance. The estimated burden for completing this form is 3 minutes. You are not required to respond to any collection information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to: U.S. Small Business Administration, 409 3rd Street, SW, Washington, DC 20416, and to: Desk Officer SBA, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503. OMB Approval (3245-0324). PLEASE DO NOT SEND FORMS TO OMB. By completing and returning the Request For Counseling Form (SBA Form 641) by email or by fax, you have authorized an electronic substitute of your written signature on the form.
Please select: Asian Black or African American Native American or Alaska Native Native Hawaiian or other Pacific Islander White
Please select: Hispanic Origin Not of Hispanic Origin
Please select: Male Female
10) Do you consider yourself a person with a disability?
11) Veteran Status
Please select: Non-Veteran Veteran Service-Disabled Veteran
12) Military Status
Please select: On Active Duty Member of National Guard Member of Reserve None
13) What prompted you to contact our office? (Select all that apply)
14) Special SBDC Client Types (Select all that apply.)
15) Are you currently in business?
Questions 15a-27 are required if you are currently in business.
15c) If in business, are you currently exporting?*
18) What is your position in the company?*
Please select: Owner/Sole Proprietor Employee President Vice-President Partner Other
19a) Type of Business (Select primary category.)*
Please select: Manufacturing Wholesale Construction Retail Services Other
19b) Please describe your product or service; include NAIS code(s).*
20) What is the legal entity of your business?*
Please select: Sole Proprietorship S-Corporation Corporation Partnership LLC Other
21) Business Ownership: What is the gender of the business owner(s?)*
Please select: Male Female Male & Female Owners
22) Do you conduct business online?*
23) Is this a home-based business?*
24) Are you 8(a) certified?*
25) What is your SBA relationship?*
Please select: Applicant Borrower COC Procurement Assistance Technical Assistance
28) Area of Assistance Requested (Select all that apply.)
Thank you very much for taking the time to fully complete this form.
Texas State Small Business Development Center
Thank you very much for contacting the Texas State Small Business Development Center for assistance with your small business. Our office provides many services and programs designed to help small business owners and entrepreneurs start, improve, or grow their small businesses.
Some of these services include providing one-on-one counseling, assistance in writing a business plan, various types of business training, and help with marketing research.
If you have not been contacted within 24 hours please call our office for assistance. If you are a new/non existent business, please sign up for our Start Up Orientation which is held approximately every two weeks. utsa.ecenterdirect.com/Conferences.action