Small Business Assistance Center Network

Network Access Survey

FINANCIAL REFERRAL NETWORK FINANCIAL REFERRAL NETWORK
Amount of loan/credit line sought $_______________
Do you own real estate? YES YES   NO NO
  If yes, how much equity do you have? $______________
How long has your business been established? __________ years

BUSINESS COUNSELING BUSINESS COUNSELING
Please list the area of expertise in which you need business counseling
(i.e., start up, marketing, benefits, investing, tax, legal, etc.)

_____________________________________________

_____________________________________________

MEDICAL/DENTAL & BENEFITS PACKAGE REFERRAL MEDICAL/DENTAL & BENEFITS PACKAGE REFERRAL
Number of employees __________ Average age of employees __________
Are you interested in medical insurance? YES YES   NO NO
Are you interested in dental insurance? YES YES   NO NO
Are you interested in life insurance? YES YES   NO NO
Are you interested in disability insurance? YES YES   NO NO

INTERNET BASED PAYROLL & HUMAN RESOURCES SERVICES INTERNET BASED PAYROLL & HUMAN RESOURCES SERVICES
Are you interested in internet based payroll services? YES YES   NO NO
Are you interested in other human resources services? YES YES   NO NO

BUSINESS SEMINARS AND WORKSHOPS BUSINESS SEMINARS AND WORKSHOPS
What business seminar/workshop topics interest you?

I am interested in: _______________________________________________________

OTHER SMALL BUSINESS SERVICES OR INFORMATION OTHER SMALL BUSINESS PRODUCTS, SERVICES OR INFORMATION

I am interested in: _______________________________________________________

I am interested in: _______________________________________________________


COMPANY/INDIVIDUAL NAME
ADDRESS
CITY STATE ZIP CODE

TELEPHONE FAX

CONTACT PERSON EMAIL

HOW LONG HAVE YOU BEEN IN BUSINESS?

Fax, mail or email this form to us! inquire@sbacnetwork.org



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Small Business Assistance Center • 90 Daniel Drive, Avondale, PA 19311 • Phone (610) 444-1720