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Leave blank if you do not have a name chosen or the business name is the same as your name.
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Your position or title related to this business
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Your physical street address (number and street) of the business. If a home based business, or the business has not started yet, use your home address.
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Optional. Use if you need additional address postal information like apt, floor, suite, etc., or a PO box.
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Business has started
Check if you have started conducting business. Leave unchecked if you are in the planning stages and have yet to start this business.
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Legal entity of the business
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Current Number of Full Time Employees
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Current Number of Part Time Employees
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Annual Sales $ for the most recent full business year
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Annual Profit/Loss $ for the most recent full business year
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Yes
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Current Number of Total Export Related Employees
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Export Related Sales for most recent full business year
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Please read the following, enter your Full Name, and click Continue below to indicate your acceptance.
I request business counseling service from the Small Business Administration (SBA) or an SBA Resource Partner. I agree to cooperate should I be selected to participate in surveys designed to evaluate SBA 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.
I self-certify that neither I nor my company are currently in suspension or debarment by a Federal Agency.
Please enter your full name, indicating your acceptance of the above terms.
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Date: 5/7/2025 6:28:48 PM
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