Request for Counseling Form

Please note: The information gathered from this form is used only by Small Business Development Center staff and is NOT made public.

Contact information: (Items with * are required)

First Name:*
Last Name: *
Business Name: *

Address:*
 
City:*
State/Province:*   Zip:
Country
Website Address:
Email Address:*

Phone Numbers:
Home:
Business:
Cellular:

Business Information:
Currently in Business? *  
Is this a Home-based Business?*  
Business Owner(s) Gender(s):*  
Race :*  
Veteran Status :*  
Business Status:*  
SBA Client (Past or Present):*  
Export :*  
Business Type :*  
Counseling Type:*  
Describe your business:
  
Request for counseling information*
Describe the nature of the counseling you are seeking


Best time for contact:
Best Contact Method:

Would you like to tell us more about yourself and/or your business? 
Fill out the optional fields below to better prepare your advisor for your meeting. 
New York State Small Business Development Center Client Disclaimer (Required)

I request management assistance from The New York State Small Business Development Center. I understand that this assistance is free of charge and that I incur no obligation to The New York State SBDC or the U.S. Small Business Administration or its counselors for providing this assistance. I agree to cooperate should I be selected to participate in surveys designed to evaluate assistance services. I authorize the NYS/SBDC to furnish relevant information to the assigned management counselor(s) although I expect that information to be held in strict confidence to the extent allowable by law.

I further understand that any counselor has agreed not to: (1) recommend goods or services from sources in which he/she has an interest and (2) accept fees or commissions developing from this counseling relationship. In consideration of the SBDC, in cooperation with the SBA furnishing management or technical assistance, I waive all claims against The New York State SBDC, SBA, personnel or counselors arising from this assistance.




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NYS Small Business Development Center
State University Plaza
Corporate Woods Building, 3rd Floor
Albany, NY 12246
In NY State (800) 732-SBDC
Outside NY State (518) 443-5398

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Partnership Program with the SBA, administered by the State University of New York. This Cooperative Agreement is partially funded by the U.S. Small Business Administration. SBA’s funding is not an endorsement of any products, opinions, or services. All SBA funded programs are extended to the public on a nondiscriminatory basis.