| 1. |
. |
Print
full name of the individual)s) requesting counseling. |
| 2. |
|
Give
telephone and FAX number including area code(s). |
| 3. |
|
Print
E-mail address including Internet Service Provider. |
| 4-8. |
|
Print
complete address as indicated. Please include Postal ZIP Code. |
| 9-14. |
|
Mark
all boxes as appropriate. |
| 15. |
|
Describe
the business function(s) for which you are seeking counseling.
Some examples of such functions are Business Planning,Marketing,
Sales, Financial Management, Insurance and Legal Structure. If
you are not currently in business then describe the business
which you wish to start. If you need more room write on a separate
sheet and include with the completed Form 641. |
| 16. |
|
Mark
all Boxes as appropriate. |
| 17. |
|
Describe
the business you are currently running. This description taken
together with the listing in Section 15 of your counseling needs
will enable us to assign the most qualified SCORE Counselor to
your request. |
| 18. |
|
Print
the name of your company. Leave blank if you are not already
in business. |
| 19. |
|
Give
length of time that your company has been in business. Leave
blank if you are not already in business. |
| 20. |
|
Indicate
preferred date(s) and time(s) for the first appointment with
SCORE counselor. |
