• Service Request Form

  • Small Business Intake

    Please complete this form before scheduling your appointment.

  • Your Information

  • Format: (000) 000-0000.

  • Your Address

  • Address Type*

  • Your Business

    Please answer a few questions about your business or business idea.
  • Are you currently in business?*

  • IN BUSINESS: A business is considered in business if it has completed required registration(s), if applicable, AND at least one of the following: generating revenue, obtaining business funding, hiring employees or contractors, or incurring business expenses.

  • Which of the following do you currently have? (Select All That Apply).*
  • What is your business structure?*
  • Business Start Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Conducting Business Online*

  • Business Mailing Address

  • Do you operate your business from your home?*

  • Requested Services

  • Referral Information

    Help us understand how you heard about The Iowa Center.
  • How did you hear about us? (Select All That Apply)*

  • Demographic Information

  • The information below is collected for reporting purposes and helps us measure the impact of our programs. It does not affect your eligibility for services.

  • Personal Information

  • Date of Birth*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Race (Select All That Apply)*

  • Military & Education

  • Employment Status (Select All That Apply)*

  • Household Information

  • Consent & Certification

    Please review the information below before submitting your request.

  • Iowa Center Story Authorization

  • May The Iowa Center use your story, quote, and personal likeness and publicly acknowledge you as a client?*

  • Client Agreement

    I request business counseling service from an SBA Resource Partner. I authorize SBA or its agents to furnish relevant information to the assigned management counselor(s). I further understand that the counselor(s) agrees not to: 1) recommend goods or services in which he/she has an interest, and 2) accept fees or commissions developing from this counseling relationship.

    In consideration of the counselor(s) furnishing management or technical assistance, I waive all claims against SBA personnel, and that of its Resource Partners and host organizations, arising from this assistance.

    I understand that any information disclosed will be protected to the extent permitted by law. (SBA or its agents will not provide my personal information to commercial entities.)

  • Use of Information

    The information in this form is to be provided by individuals and businesses seeking technical assistance services from an SBA Resource Partner.

    The information is collected to help SBA’s continuing improvement of business counseling programs, to ensure effective oversight and management of entrepreneurial development programs and grants, and to meet Congressional and Executive Branch reporting requirements.

    Resource Partners will submit information to SBA according to the terms of their notice of award.

  • Participation in Surveys and SBA Communication

    I agree to cooperate should I be selected to participate in surveys designed to evaluate SBA Resource Partner services. I permit SBA or its agent to use my name and address for SBA surveys and informational mailings regarding SBA products and services.

  • Consent to Survey Participation*

  • Certification

    I certify that the information provided on this form is complete and accurate.

  • Should be Empty: