Business Resources Client Form

REI Oklahoma Business Resource Center Client Intake Form
Thank you for providing this information. By answering the following questions, you will assist us in our efforts to best serve you through our Business Resource Center, which includes the REI Women’s Business Center, the REI Minority Business Center, as well as other entrepreneurial and business programs and services. All data shared will remain confidential and only used for internal reporting.
General Information
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
County
Phone Number*
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 assistance requested:
Demographic Information

This information helps identify certifications and opportunities that may apply to you and your business.
What is your gender?*
Do you consider yourself as a person with a disability?*
What is your race?*
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?*

YesNo
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?*

YesNo
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: *

Amounts ($)

Revenue related to exporting
Please select any registrations your business holds with the Small Business Administration (SBA).
Sign and submit
I agree to the disclosures.I give my consent to receive communications from REI Oklahoma.
E-Signature*

Clear
Please verify that you are not a robot*
Should be Empty:

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

REI Oklahoma Business Resource Center Client Intake Form

General Information

Demographic Information

Business Information

Sign and submit