Leave blank if you do not have a name chosen or the business name is the same as your name.
Your position or title related to this business
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.
Optional. Use for additional address postal information like apt, floor, suite, etc., or a PO Box.
Check if you have started conducting business. Leave unchecked if you are in the planning stages and have yet to start this business.
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 certify that neither I nor my company are currently in suspension or debarment by a Federal Agency.
I certify that I am legally authorized to receive taxpayer-funded assistance under federal law. I understand that the Tennessee Small Business Development Center is prohibited from providing services funded by taxpayer dollars to individuals not lawfully present in the United States. I affirm that the information provided is accurate.
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