Business Resources Client Form

REI Oklahoma Business Resources Client Intake Form
Thanks for sharing this information! By answering the questions below, you'll help us better serve you through REI Business Resources. Your responses will stay confidential and are only used internal purposes.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
General Information
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
County
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Are you currently working with a Business Resources team member?
Select the name on of the individual you are working with.
What is the nature of counseling you are seeking?
Describe specific or additional assistance requested:
Demographic Information

This information is for statistical purposes only and will not impact the assistance you receive from our programs & services.
What is your sex?
Do you consider yourself as a person with a disability?
What is your race?
Please enter race here.
What is your ethnicity?
What is your military status?
Do you consider yourself economically disadvantaged?
Who were you referred by?
Please share who referred you.
Please share the website that referred you.
Business Information
Are you currently in business?
What is the legal structure of your business?
If you selected other, please enter your business legal structure here.
Business Name
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
What is the date your business started?
MM/YYYY
What is the current stage of your business?
Do you have a website or social media page?
Please enter your website or social media page(s).
Type of business:
If selected other, please provide additional details.
Company NAICS Code(s): Please limit to 5 codes.
Check all that apply.
What is the percent of female ownership in your business?
How many individuals does your business employee?
Include full time and part time employees. Do not include contract/1099 workers.
Of total employees, how many are engaged in the exporting aspect of your business?
Full time and part time employees.

For your most recent full business year, what was your:

Rows Amounts ($)

Revenue related to exporting
Please select any registrations your business holds with the Small Business Administration (SBA).
Sign and submit
E-Signature
Please verify that you are not a robot
Counseling Seeking
Should be Empty:

Rows	Amounts ($)
Gross Revenue / Sales
+ Profits / - Losses

REI Oklahoma Business Resources Client Intake Form

General Information

Demographic Information

Business Information

Sign and submit