Business Enterprise Centre Intake Form

Business Enterprise Centre Intake Form

Please provide all required details to register for an appointment with the Business Enterprise Centre
Business Owner*

First Name Last Name
Business Name/Proposed Business Name
Contact Number*
E-mail*
example@example.com
Please indicate the date that you business was or will be established:
blanks Month blank Year
If your business has a website, please provide the URL/Address below:
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
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:*

TelephoneVirtual - MS TeamsIn person
Please indicate what the Business Enterprise Centre can help you with at this time:*
Type of Business Service Requested:*

New Business Idea/Entrepreneurship ExplorationBusiness Plan for a new businessBusiness Plan for an existing businessAdvisory support for a new start up businessAdvisory support for an existing businessAdvisory support for purchasing a businessAdvisory support for succession planning or selling a businessOther (please specify below)
Other (please specify)
If known, please indicate the structure of your business:

Sole ProprietorshipPartnershipCorporationNot sure
If your business in currently in operation, how many people are employed by the business (including yourself as owner/operator)?
I am interested in on-going Business Education through the Business Enterprise Centre, specifically relating to (choose all that apply):*

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 InclusionNoneOther
Other (please specify)
Where did you hear about the Business Enterprise Centre?*

Small Business Centres OntarioAn AccountantA LawyerMunicipal or Government OfficeFriend or Business AssociateLambton County LibrariesMy Member of Parliament (MP) or Member of Provincial Parliament (MPP)Chamber of Commerce, Business Development Corporation, Business Improvement Association, Agricultural Association, Professional Association, or UnionBank, Credit Union or Trust CompanyLocal Media (such as radio, newspaper, television)Social Media (such as Facebook, Instagram, LinkedIn, Twitter, TikTok)Ontario Works (OW) / Ontario Disability Support Program (ODSP)Internet SearchOther
Other (please specify)
The Business Enterprise Centre (BEC) recognizes the importance of the privacy and protection of clients' personal information. The BEC complies with all municipal and provincial privacy legislation. Personal information may be required in connection with purchases, service requests, event registrations and program applications.

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
Personal information listed below 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. The information shared will include:
- the Business’ legal name
- website address
- the name and email address of the contact person
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 BEC to maintain records of my personal or business information:*

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*

Clear
Should be Empty: