Alliance Business Technical Assistance Client Interest Form

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Our Business Technical Assistance Team stands ready to help you navigate your business through this crisis and get on the road to recovery. Please complete this intake form and a consultant will respond quickly.

Email *

First, please tell us how you heard about us.

What is your name? *

What is your company name? *

Please give us a brief description of your business *

Please list your business website (or N/A if you do not have one) *

What is your phone number?

Please describe your business structure *

Sole Proprietorship

Non-profit

Partnership

Corporation

S Corporation

Limited Liability Company (LLC)

Other/Not Sure

How long have you been in business?

What is your business address and zip code? *

What were your annual business gross revenues (in your most recent full business year)?

How many employees do you have? *

What is your residential zip code?

Additional assistance may be available for business owners from disadvantaged populations. If you’d like to share more about yourself, the consultant can be prepared to connect you with appropriate help. If desired, please indicate which may apply to you.

Low-to-Moderate Income (Household income less than $58,000/year)

Hispanic/Latino

African American

Asian and Pacific Islander

Woman business owner

Veteran

Person with a Disability

Limited English Proficiency

Limited Technology Proficiency

Other:

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