Client Application
Small Business Clinic (SBC)

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There is a waiting list to become an SBC client. It may take several weeks for the SBC to respond to applications submissions.

This Application Form will be submitted directly to the SBC. The Application Form enables the SBC to make an initial evaluation of potential clients. Please provide as much information about your business as possible. If there is any section of the Application which does not apply to your business, just put "N/A" in the blank. If your Application is accepted, the SBC will contact you to schedule a time for a more formal intake interview.

Thank you for your interest in the SBC.

* denotes required field

Applicant Contact Information Business Name:*
Authorized Contact Person:*
Contact's Phone Number:*
Contact's Fax Number:
Contact's Email Address:*

Business Information Business Description (including products sold and/or services provided and geographic area(s) served):*

Have any entities (e.g. corporation, LLC, etc.) already been formed? *

Yes No

Please provide the business start date or anticipated start date: *

Start Date:

How many people will be involved in forming, operating and financing the business?*

People Involved:
Please list them and the roles they will play (e.g. founder, investor, etc.):

Capitalization of Business

Approximately, how much money is being used to start the business?

Enter Dollar Amount: *
Funding will come from:*

Does Client have or plan to have more than one class of ownership? *

Yes No

Will loans be made to the business by shareholders, banks or others? *

Yes No

Other Legal Agreements or Matters Please list any other legal work that has been done for the business as well as any issues or matters about which we should know:

Project Description Please describe the project(s) with which you are seeking assistance from the Small Business Clinic: *