Set Up An Appointment

Name*
First Last
Title*
Company Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Cell Phone
Business Phone
Email*
Website
Business Information
What would you like to see a business counselor about?*
Check all that apply
- Start-up Assistance (How do I start a small business?)
- Business Plan Financing/Capital (such as applying for a loan)
- Managing a Business
- Human Resources/ Managing Employees Customer
- Relations Business Accounting/ Budget
- Cash Flow Management
- Marketing/Sales (promotion, market research, pricing, etc.)
- Government Contracting (including certifications)
- Franchising Buy/Sell Business
- Technology/Computers
- eCommerce (using the Internet to do business)
- Legal Issues (such as, Should I incorporate?)
- International Trade Tax Planning
Currently in Business?*
- Yes (existing business)
- No (starting a new business)
If the Answer is yes, when was the start date of the business?
Month & Year
What is the legal structure of your business?*
Percent Woman Owned*
Home-based business?*
- Yes
- No
Is it an online business?*
- Yes
- No
Total No. of Full-Time Employees*
Total No. of Part-Time Employees*
For your most recent full business year, what were your full Gross Revenue/Sales?*
For your most recent full business year, what were your profit/loss?*
Demographic Information
Preferred Language*
Race:
Disability:
- Yes
- No
- Prefer not to say
Veteran Status:
- Non-veteran
- Veteran
- Service Related Disabled
- Military Spouse
Ethnicity:
- Non-Hispanic or Latino/a
- Hispanic or Latino/a
- Prefer not to say
Gender Identify As:
- Male
- Female
- Non-Binary
- LGBTQ
- Prefer Not to Say
Client Release
I request training and/or business counseling service from Prestamos Women’s Business Center (Prestamos WBC), funded in part through a Cooperative Agreement with the U.S. Small Business Administration (SBA). I agree to cooperate should I be selected to participate in surveys designed to evaluate these services, impact, and/or make improvements on services. I understand that any information disclosed will be held in strict confidence. (SBA and the WBC will not provide your personal information to commercial entities.) I authorize SBA and the WBC 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 and WBC personnel, and that of its Resource Partners and host organizations, arising from this assistance.

Business Information

Demographic Information

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