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Small Business Membership Form

Contact First Name:
Contact Last Name:
Business Name:
Email Address:
Please provide at least one phone number.
Cell Phone
Home Phone
Work Phone
Work Extension
Best Time To Reach You:
What is your primary industry?
How many locations do you have?
How many employees do you have?
What type of help are you looking for?
What area of your business needs the most attention?
If you are seeking financial relief, did you apply for the PPP loan and was it granted or declined?
If declined, what was the reasoning?
Would you like to be connected with a local business expert volunteer to consult with you about your business?
If so, what area of your business are you requesting a consultation for?
How are you currently capitalized?
Do you see yourself having interest in expanding your business in the future?
What other information would you like us to know?
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