Tell Us About Your Business Needs
We consider it a privilege and honor to help you plan and execute excellence for your business.
This meeting will be confidential between you and your Chamber Adviser. However, we like to have all appointments recorded for your archives. This will allow you to go back to this valuable session at a later date and pick up something that might have been missed. Do we have permission to record your appointments?
Yes
No
Your Organization Information
Do You Have A Business?
Yes
No
If Yes, List Your Business Name
Your Organization Name:
If Yes, List Your Business Title
Your Business Title:
First Name:
Last Name:
Race/Ethnicity
Your Organization's Mailing Address (No P.O. Box), Please Include City and State
Your Organizations Mailing Address:
Your Email Address
example@example.com
Your Phone Number (Best Contact)
Please enter a valid phone number.
If Applicable, who referred you?
First Name
Last Name
Your Organization Information
Business Start Date
-
Month
-
Day
Year
Date
If You Haven't Started A Business, Type N/A
Years In Business:
Organization Description (products, services, who it serves):
Organization Website:
If no website, type N/A
Geographical area served:
Business Type:
C-Corp
S-Corp
LLC
Sole Proprietor
Partnership
Average Annual Revenue:
$0
$10,000-$100K
$100K-$300K
$300K-$500K
$500K and above
Number of Employees
Have you ever applied or received any SBA services in the past 5 years? If so, please select an item in the list.
None
Paycheck Protection Loan
Covid Economic Injury Disaster Loan
Restaurant Revitalization Fund
Shuttered Venues Grant
Other SBA Disaster Loans
Microloan
7(a) or 504 guaranteed loan
8(a) Certification
Other
Do you identify as disabled?
Yes
No
Are you a veteran of the US Military?
Yes
No
Your Professional/Business Expertise
How long have you been in the industry:
What certification/credentials do you have?:
Have you worked with Consultants/Coaches before?
Yes
No
Not sure
If so, how did it work out/was it valuable? Share with us a little bit about it.
Your Business/Professional Areas Of Need:
Areas/departments where you need support:
Choose as many as apply:
Strategy
Business Plan
Workflow
Team Efficiencies
Operations
Human Resource
Finance/Funding
Product/Services
Marketing
Social Media
Sales
Customer Service
Business Technology
Other Areas:
What critical challenge(s) do you believe hinders your business growth/expansion?
Pick all that apply:
Expertise
Product and/or Services
Funding
People
Processes and/or systems
Other
The more info and examples you can share here before we meet with you, the more prepared we will be to provide real value and support to you and your business.
Your Availability To Meet/Share:
What is your availability (days of the week, hours, etc)
For quick communications, are you phone, text or email centric?
Please Select
Phone
Text
Email
How do you prefer to interact? Phone, zoom or in-person (if geographically desirable)
Please Select
Phone
Zoom
In person (If geographically desirable)
Please provide us a date & time that would be best for you to review your assessment. A consultant will be in contact with you shortly after they receive your information. We look forward to working with you!
Submit
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