Top view woman writing in note book is freelancer with her private business at home office, Selling online start up small business owner SME idea concept Sign up for CA Shop Small Training Cohort. 1Step One: Personal Profile2Step Two: Business Profile3Step Three: Submit Let's set up your client profile…Name* First Last Email* Phone*Home Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you in business?Are you in business?* Yes No, not yet To be considered in business, you must meet at least one of the following criteria: 1. acquired debt or equity, 2. incurred business expenses, 3. sold a product to customers not friends or family, 4. paid employees or contractors. Ok, tell us about your business…Business Name* Date Business Established* MM slash DD slash YYYY Business Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your Position in the Company*CEOEmployeePartnerPresidentSole ProprietorVice PresidentGeneral ManagerOwnerDescribe your business* Ok, tell us about your goals…Describe your business idea* HiddenWrap UpReferred by*Business OwnerLenderAdvertising/MarketingLocal Government AgencyState Government AgencySBAInternet: EmailInternet: Social MediaInternet: WebsitePartners: PTAC, SCORE, WBC, VBOCTrade AssociationsOtherReferred by Other* Please specifySubscribe to our newsletter?* Yes No thanks Terms of ServiceINFORMATION NOTICE OMB Approval No.:3245-0324 I request business counseling service from the Northern California Small Business Development Center (SBDC) Network, an SBA Resource Partner. I agree to cooperate should I be selected to participate in surveys designed to evaluate SBDC services. I understand that any information disclosed will be held in strict confidence. (The SBDC will not provide your personal information to commercial entities.) I authorize the SBDC to furnish relevant information to the assigned Business Advisor(s). I further understand that the advisor (s) agree 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, host organizations, and SBDC Advisors arising from this assistance. By accepting these terms you agree, if selected, to participate in surveys designed to evaluate the services and impact of the Northern California SBDC Network. Any information disclosed in such surveys will be held in strict confidence. Please note: 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.Signature*Please provide your full name (First, Middle, Last) indicating your acceptance to the terms shown above. Privacy Release*OPTIONAL: CHECKING THIS BOX IS NOT A REQUIREMENT TO RECEIVE SBDC 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. SBA will not provide your personal information to commercial entities. Yes No thanks
