First Name *

Last Name *

Company Name (if applicable)

Company Address *

City *

Zip Code *

County *

E-Mail *

Phone *

Website Address (www.yoursite.com)

Are you in business now? * NoI want to start a businessYesI am in business now

If in business, how long? * Less than 6 monthsLess than 1 yearLess than 2-5 yearsOver 5 years

Have you completed required local/state/federal registration(s)? * NoYes

If yes, please identify which type of registration. *

The SBA has specific criteria it uses in the definition of "in business". Please choose one or more of the qualifying criteria below that your business meets. (To select more than one option, Ctrl + click.) * Generated RevenueAcquired Debt or Equity InfusionAcquired Human ResourcesIncurred Business Expenses

What is your role in the company? * Pre-Venture: Visionary/FounderPre-Venture: Founding Team MemberOwnerLLC Member or LLC ManagerCorporate Board MemberManager/ManagementOther Staff/Employee

Is your primary residence located in Dallas County? * YesNo

Is or will your business be located in Dallas County? * YesNo

If no, what county will your business be located in?

If currently in business, what were your total sales (revenue) last year?

If currently in business, what was your net profit last year?

Describe your existing business, or the business you are considering starting *

Describe the kind of assistance needed for your business. *

Do you need financial resources, such as a loan to start or expand your business? * YesNo

If yes, how much money do you need? $0 - $1000$1001 - $5000$5001 - $10000$10001 - $25000$25001 - $50000$50001 - $100000$100001 - $250000More than $250000Unsure

How would you rate your personal credit history? * ExcellentGoodFairPoorUnsure

If known, what is your credit score?

Do you have financial resources to put towards opening or expanding your business? * YesNo

If yes, how much? (in dollars)

Do you have a relationship with a lender? * NoYes

If yes, please provide your bank and lender contact. *

How did you hear about the Dallas Metropolitan SBDC? * Internet SearchSocial MediaClient/Word of MouthBank/LenderCollege/UniversityCounty/CityGovernmentLocal Economic DevelopmentSBASCOREOther SBDC Location

Did someone refer you to the SBDC? If so, who? *

Additional Comments

1 + 3 = ? Please prove that you are human by solving the equation *