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Request Counseling Session


Personal Information:

 

 
 
 

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.


Business Information:

Questions 15a-27 are required if you are currently in business.

 
 
 
 
 
 
 
 
 
 
 
 

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