Counseling Request Form -

Instructions:

  • Fill in the information below, then click on the Submit button. All fields are required. If you are having trouble with this form or would like to speak with someone in our office, please call 302-573-6552  

First Name

Last Name        

Email Address

Day Phone Number - (digits only)          Evening Phone Number - (digits only)  

Address

 

City 

State

Zip

Currently In Business? Yes No Since / (ex 04/2006)
Company Name  

Ownership (both boxes must equal 100)

% Male       % Female  

Describe the Type of Business you have questions about:

 

Describe the assistance you are seeking and your business idea/issue in sufficient detail for us to assign the best qualified counselor

 

How did you hear about SCORE:  

-SBA

-Bank

-Business owner

-Televison/Radio

-Other Client

-Magazine

-Internet

-Newspaper

-Chamber of Commerce

-Educational Institution

-Local Economic Devel. Offical

-Word of Mouth

-Unknown

-Other

Terms & Conditions:
In requesting services from the Small Business Administration (SBA) or an SBA Resource Partner (SCORE). I agree to cooperate should I be selected to participate in surveys designed to evaluate SBA services. I permit SBA or its agent the use of my name and address for SBA surveys and information mailings regarding SBA products and services. I understand that any information disclosed will be held in strict confidence. (SBA will not provide your personal information to commercial entities.) I authorize SBA 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 from sources 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.


What Happens Next: Once we receive your form by any of these means, we will assign a counselor ( or a team of counselors) best qualified to help you. In a few days the counselor will call you and setup an appointment. At that point, the rest is between you and your counselor.