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:
If Yes, list your business title:
What is the NAICS code for your business?
Separate multiple codes by commas.
Your Basic Information:
*
First Name:
Middle Name
Last Name:
Suffix
What's your race/ethnicity?
Asian/Asian-American
Black/African-American
Latino/Hispanic
White
Choose not to specify
Other
If willing, please specify
Race/Ethnicity
What is your gender?
*
Male
Female
Prefer not to answer
Your Phone Number (Best Contact)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email Address
*
example@example.com
Your Organization's Physical Address (No PO Box), Please include City and State
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Your Organization's Mailing Address (PO Box OK), Please include City and State
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Do you identify as disabled?
Yes
No
Are you a veteran of the US Military?
Yes
No
If Applicable, who referred you?
First Name
Last Name
Do you have a preferred counselor? If yes, please choose from the dropdown list below. If not, you will be assigned a counselor.
Please Select
Aimbrell Shanks
David Daniel
James Steiner
Jessica Wright
Please Assign For Me
Back
Next
Your Organization Information
Business Start Date
-
Month
-
Day
Year
Date
Years In Business:
Organization Description (products, services, who it serves):
Organization Website:
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
What was your revenue last year?
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
In the next 2 years, will you be looking for capital in your business?
Yes
No
Are you open to take out a loan or a grant?
Loan
Grant
I may consider it
Not at all
If loan and/or grant, which amount are you looking for?
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
Digital Marketing
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!
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