| 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. |
