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KMEC Client Intake Form
Thank you for choosing the Knight Memorial Entrepreneurship Center to help with your small business/entrepreneur/artist needs!
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* Indicates required question
Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Current Address (or P.O. Box)
Your answer
Phone number
*
Your answer
Best form of contact?
*
Phone
Email
Mail
Business Name (if applicable)
Your answer
EIN (Employee Identification Number, if applicable)
Your answer
Website (if applicable)
Your answer
Business start date (if applicable)
MM
/
DD
/
YYYY
What are your plans for growth and expansion over the next two years?
*
Your answer
Business industry type
*
Art, Entertainment, Crafts
Fashion (Custom fashion design or Clothing retail)
Food Service
Healthcare, Medicine
Beauty, Cosmetology, Barbering/Hairstyling
Other:
Legal entity type (if applicable)
LLC (Limited Liability Company)
Corporation (for-profit)
Corporation (non-profit)
Partnership/LLP
Other:
Clear selection
What services are you seeking?
*
Marketing help
Financial assistance
Tech help
Business start up support
Co-working space
Other:
Required
Appointment type
*
Walk-In
By appointment (in person)
By appointment (virtual)
How did you hear about us?
*
Friend
Library website
Social media
Flyer or Brochure
Other:
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