Personal Information

First Name*


Last Name*


Email Address*


Phone Number*


Name of Business (leave blank if one does not exist)


Address (Business preferred, otherwise please include your home address)*


City*


State*


Zip Code*


Preferred Method of Communication*
-- select an option -- Email Phone Text

Age*
-- select an option -- 18-24 25-34 35-44 45-54 55-64 65+

Ethnicity/Race Group*
-- select an option -- White or Caucasian Black or African American Hispanic or Latino Asian or Asian American Native American Other

Which gender do you identify with most?*
-- select an option -- Female Male Non-binary Other or Prefer not to answer

How did you hear about us?
-- select an option -- Bank Facebook Newspaper Search Engine Word of Mouth Other

Business Information

Website


Stage of Business*
-- select an option -- Thinking of starting a business Ready to launch your business In the process of starting or acquiring a business Currently operating a business


Type of Business
-- select an option -- Accomodation Construction Manufacturing Real Estate / Rental / Leasing Retail Service Wholesale / Distirbution Unknown at this time Other


Approximate annual revenue (how much to you expect to make each year)? Leave blank if not applicable.


Please provide a brief summary of your business or business idea.*


Are you currently working a job outside of your business venture?*
-- select an option -- Yes No

Have you ever attended any classes on starting or operating a business?*
-- select an option -- Yes No


Would you be interested in attending classes on starting or operating a business?*
-- select an option -- Yes No

Please describe any prior experience you have in starting or operating a business.


What is the top question you hope to have answered?

Language Information

How comfortable are you speaking and comprehending English on a scale of 1-5?*
-- select an option -- 1 - Very Uncomfortable 2 - Uncomfortable 3 - Neutral 4 - Comfortable 5 - Very Comfortable

Do you need an interpreter? (we’ll do our best to find someone who can assist with your language needs)*
-- select an option -- Yes No