Language
English (US)
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So You Think You Need a Bookkeeper?
Name
*
First Name
Last Name
Email (double check spelling)
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of Birth
*
-
Month
-
Day
Year
Date
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Race/Ethnicity (Select all that apply)
*
African
Asian
Black or African American
Hispanic or Latino/Latina/Latine
Middle Eastern/North African
Native American or Alaskan Native
Native Hawaiian or other Pacific Islander
White
Other
Do you require interpretation?
*
Please Select
Yes, Spanish
No
Business Information
How long have you been in business?
*
Idea Phase
Less than a year
1-2 years
2-5 years
6-10 years
10+ years
Is your business address the same as your home address?
*
Yes
No
What industry is your business in?
Please Select
Retail
Hospital
Food & Beverage
Healthcare
Technology
Manufacturing
Construction & Trades
Consulting
Financial Services
Education & Training
Marketing & Advertising
Entertainment & Media
Fitness & Wellness
Beauty & Personal Care
Agriculture
E-commerce
Automotive
Professional Services (Accounting, Tax Services, etc)
Creative Arts & Design
Other
Name of Business
*
If you are not registered yet, enter N/A
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Household Information
This data allows us to continue to receive the necessary funding to offer services at no cost to our clients.
Household Size
*
Please Select
1
2
3
4
5
6
7
8
9
10
11 or more
Select your ANNUAL Gross Household Income (1 Person Household)
*
Please Select
Less than $24,800
$24,801 - $41,300
$41,301 - $66,100
Over $66,101
Select your ANNUAL Gross Household Income (2 Person Household)
*
Please Select
Less than $28,350
$28,351 - $47,200
$47,201 - $75,550
Over $75,551
Select your ANNUAL Gross Household Income (3 Person Household)
*
Please Select
Less than $31,900
$31,901 - $53,100
$53,101 - $85,000
Over $85,001
Select your ANNUAL Gross Household Income (4 Person Household)
*
Please Select
Less than $35,400
$35,401 - $59,000
$59,001 - $94,400
Over $94,401
Select your ANNUAL Gross Household Income (5 Person Household)
*
Please Select
Less than $38,250
$38,251 - $63,750
$63,751 - $102,000
Over $102,001
Select your ANNUAL Gross Household Income (6 Person Household)
*
Please Select
Less than $41,960
$41,961 - $68,450
$68,451 - $109,550
Over $109,551
Select your ANNUAL Gross Household Income (7 Person Household)
*
Please Select
Less than $47,340
$47,341 - $73,200
$73,201 - $117,100
Over $117,101
Select your ANNUAL Gross Household Income (8 Person Household)
*
Please Select
Less than $52,720
$52,721 - $77,900
$77,901 - $124,650
Over $124,651
Select your ANNUAL Gross Household Income (9 Person Household)
*
Please Select
Less than $55,700
$55,701 - $79,000
$79,001 - $126,300
Over $126,301
Select your ANNUAL Gross Household Income (10 Person Household)
*
Please Select
Less than $60,840
$60,841 - $83,500
$83,501 - $133,500
Over $133,501
Household Size
*
ANNUAL Household Income (do not include $ or commas)
*
Do you have a disability?
Yes
No
I rather not say
Do you have children under 18 years old attending local schools?
*
Yes
No
What schools do your children attend?
This allows us to work with Family Community Resource Centers (FCRC) to provide support to families
*All information collected is kept strictly confidential and will only be used for the purpose of communication regarding the service, program, or opportunity being offered, and will not be used for any other purposes.
By attending this event, you agree to be photographed and/or filmed and give permission to use your likeness in promotional and/or marketing materials.
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