Part I. Contact Information

Contact Information
Business Address
*Please indicate the location where business activities take place, do not enter a PO Box.
Business Information
Please enter exactly 9-digits without dashes or special characters

*If you do not have an employer identification number because the small busines is a sole proprietorship, enter the primary business owners social security number or tax identification number. Remember, all information you provide is confidential and securely stored. We will not use this information for any reason except ensure your records are properly matched in our internal databases.

Part II: Business Characteristics

Select "0" if you have no employees based on the below definition:  Include all individuals receiving payroll compensation from the business.   Count the owner(s), if they receive any compensation from the operation of the business.  Do not count any contract positions.
Search by NAICS number or industry keyword

Part III. Assessment Questions




Does the small business entity currently have open and/or carry balances on any of the below credit products?
Open, Paid in Full Monthly Open, Pay Minimums Only Open, Pay More than Minimums Don’t Have This Product
Open, Paid in Full Monthly Open, Pay Minimums Only Open, Pay More than Minimums Don’t Have This Product

Does the small business currently utilize, or do you have a desire to learn about, any of the below skills and associated software?
Currently Utilize, Want to Learn More Don’t Currently Utilize, Want to Learn More No Interest
Currently Utilize, Want to Learn More Don’t Currently Utilize, Want to Learn More No Interest
Currently Utilize, Want to Learn More Don’t Currently Utilize, Want to Learn More No Interest
Currently Utilize, Want to Learn More Don’t Currently Utilize, Want to Learn More No Interest

Please indicate what types of financial assistance the small business has applied for, if any.
Approved Declined Did Not Apply
Approved Declined Did Not Apply