 Women Business Centers
at CEI
REQUEST FOR COUNSELING
As strategic allies, the Maine SBDC and the WBC collaborate to offer training workshops, seminars, and programs tailored to women-owned businesses and others as appropriate; promote and facilitate awareness of each other’s services, and mutually seek funding opportunities to support joint projects and services for women-owned businesses through statewide programming. The Maine SBDC provides ongoing counselor training and certification to WBC counselors; access to the Maine SBDC databases to track client activity and the interaction of WBC/Maine SBDC counselors; access to Maine SBDC operational and training technologies and business counseling tools; and assist, as appropriate, in the management of the WBC. The WBC furnishes training and support to the Maine SBDC on the uniqueness of women business owners and how to best assist them.
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First Name:
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Last Name:
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Position:
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Business Phone: (207-555-5555)
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Office Use |
Business Name:
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Business Fax: (207-555-5555)
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Check to be excluded from SBDC Mailings
(does not apply to surveys)
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Mailing Address
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Home Phone: (207-555-5555)
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County |
District |
City
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State
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ZipCode
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Email
WebPage
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Disabled/Handicap
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Business Status:
Currently in Business
Home Business
Online Business
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Business Start Date (format 12/31/2008)
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What percentage of your business is female owned?
%
Number of Employees
Full Time
Part Time
Annual Sales:
Annual Profit/Loss:
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Gender:
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Type of Business:
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NAICS Code(s) What is this?
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Veteran Status:
Military Status:
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Business Organization:
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Race:
Asian
Black or African American
Native American
Native Hawaiian or Pacific/Islander
White
No Reply
Hispanic Origin
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Business Description: (Briefly
describe your business [50 char])
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Indicate Preferred date and time for appointment:
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Indicate, briefly, the nature of
the service and/or counseling you are seeking:
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Release |
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I request business counseling service from the Women's Business Centers (SBA Resource Partners).
I agree to cooperate should I be selected to participate in surveys designed to evaluate SBA services.
I understand that any information disclosed will be held in strict confidence. (Maine SBDC, Women's Business Centers at Coastal Enterprises Inc. or SBA 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 (Maine SBDC and Women's Business Centers) and host organizations, arising from this assistance. |
Please Print your full name
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I agree with the above statement and accept the terms by checking this box.
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Date
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Please contact Chris Long at (207) 780-4949 if you have problems with this form. |