Business Enterprise Centre Intake Form

Business Enterprise Centre Intake Form

Please provide the information requested below about you and your business so we can create a Sarnia-Lambton Business Enterprise Centre (BEC) client account and initiate a request for a small business consultation with one of our advisors.
Looking for service in French? / Vous préférez le service en français?

Pour recevoir information ou un soutien en français, veuillez contacter Federation de gens d’affaires francophones de l’Ontario (FGA), au 647-510-3445 ou info@fedefranco.ca
Name*

First NameLast Name
Your Business Name or Proposed Business Name
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Website or primary social media page
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If your business is currently operating, when did you or start operating?
blanks Month blank Year
If your business is already registered, when did you register your business?
blanks Month blank Year
If known, please indicate the structure of your business:

Sole ProprietorshipPartnershipCorporationNot sure or not yet registered
If you are operating, how many people are currently employed by the business (including yourself as owner/operator)? Use 0.5 to count any part time staff.
Briefly describe your business or business idea in a few sentences.
Have you registered with the Business Enterprise Centre before?*

Yes, for this businessYes, for another businessNo, this is my first visit
Preferred method of consulting appointments:*

Virtual - TelephoneVirtual - MS TeamsIn person
Type of consultation requested:*

Exploring Entrepreneurship or a New Business IdeaAdvisory support for starting a businessAdvisory support for an existing businessAdvisory support for purchasing a businessAdvisory support for succession planning or selling a businessOther
If "other", please specify.
Please select any particular areas you are seeking information on or help with. This may help us direct you to relevant resource and inform future programming.*

Business LawHuman ResourcesHealth and SafetyGovernment Agencies, Services, and SupportsFinancial LiteracyFinancial Record KeepingMarketing and SalesCommunications and Public RelationsE-Commerce and Digital MediaNetworking with other Small BusinessesBusiness or Demographic TrendsBusiness CollaborationSustainable Business PracticesDiversity and InclusionSite SelectionOther
Where did you hear about the Business Enterprise Centre?*

Small Business Centres OntarioAccountantLawyerBusiness CoachMunicipal or Government OfficeFriend or Business AssociateLambton County LibrariesMy Member of Parliament (MP) or Member of Provincial Parliament (MPP)Chamber of Commerce, Business Improvement Association, Agricultural AssociationBank, Credit Union or Trust CompanyCommunity Futures LambtonLocal Media (such as radio, newspaper, television)Social Media (such as Facebook, Instagram, LinkedIn, X, TikTok)Ontario Works (OW) or Ontario Disability Support Program (ODSP)Internet SearchOther
Additional VOLUNTARY Disclosure Information

Do you self-identify as part of any of the following groups? As a publicly funded organization, the following demographic information is requested ON A VOLUNTARY DISCLOSURE BASIS and may help direct you to relevant programs, and drive policy and program design. You are not required to complete this section.
Do you self-identify as one of the following groups? If yes, select all that apply.

Francophone2SLGBTQ+Youth under 30 years of ageNewcomer to Canada (Newcomers to Canada (landed immigrants who came to Canada up to 5 years prior to a given census year)I prefer not to answer
Do you self-identify as a person with one or more disabilities?

YesNoI do not knowI prefer not to answer
Do you self-identify as First Nations, Métis, and/or Inuit? If yes, select all that apply.

Yes, First NationsYes, MétisYes, InuitI prefer not to answer
Do you self-identify as one of the following groups? If yes, select all that apply.

BlackEast/Southeast AsianIndigenous (First Nations, Métis, Inuk/Inuit)LatinoMiddle EasternSouth AsianWhiteOtherI prefer not to answer
Do you self-identify as:

WomanManNon-BinaryTwo-SpiritOtherI prefer not to answer
The Sarnia-Lambton Economic Partnership (SLEP) and associated Business Enterprise Centre (BEC), or Small Business Enterprise Centre (SBEC), recognizes the importance of the privacy and protection of clients' personal information. Personal information may be required in connection with purchases, service requests, event registrations and program applications. The information you provide will not be used except as reasonably required to provide our services.

Any information you provide that is not publicly available will be treated as confidential.

We only collect, retain and use personal information where it is essential for the following purposes:
- Process your requests for services, products or further information
- Communicate with you regarding services or products you have requested
- Identify you if you have a question or concern about a service or product you have requested
- Advise you about changes to our service offerings and of service interruptions
- Meet legal and regulatory requirements
- Meet requirements of our County and Provincial government funding partners
Your business profile will be disclosed to the Ministry of Economic Development, Job Creation and Trade and the Government of Ontario to verify service delivery of the BEC and collect feedback by requesting clients participate in a voluntary survey regarding programs and services received through our organization.

For more information about this collection, please contact:
Ministry of Economic Development, Job Creation and Trade
Business Partnerships and Programs Division
Talent and Entrepreneurship Branch
2 Queen Street East, 3rd Floor
Toronto, ON M5C 3G7
I understand and provide consent to the Sarnia-Lambton Economic Partnership and associated Business Enterprise Centre to maintain records of my personal or business information and share (as required) with regulatory and/or government funding bodies:*

YesNo
I understand that I am solely responsible for the planning, implementation, financing, operation, success and development of my business. Any advice or suggestions made are for my consideration and I am not bound to take any such advice or suggestions and can obtain advice and assistance from any source, but ultimately any decisions pertaining to my business is my responsibility. I release the representatives from the Sarnia-Lambton Economic Partnership and the Business Enterprise Centre from any claim for loss or damages suffered by me or my business, in connection with the counselling or consultation provided:*

YesNo
Signature*
Should be Empty:

Business Enterprise Centre Intake Form

Additional VOLUNTARY Disclosure Information