Part I: Contact Information

We request that you provide the below demographic data to learn more about the needs of small business owners.  You may select "Decline to State" for any question. Federal law forbids discrimination on the basis of the below information, including whether you choose to furnish it.  If you choose to not furnish this information, we note gender, race, and ethnicity on the basis of visual observation or surname.  For more information about the demographic terms below, please see our website.

Part II: Business Characteristics

Please enter exactly 9-digits without dashes or special characters

*If you do not have an employer identification number because the small busines is a sole proprietorship, enter the primary business owners social security number or tax identification number. Remember, all information you provide is confidential and securely stored. We will not use this information for any reason except ensure your records are properly matched in our internal databases.

*Please indicate the location where business activities take place, do not enter a PO Box.
Shipping address may not be a post office box.
Total should be between 0 - 99 employees. Select "0" if you have no employees based on the below definition: Include all individuals receiving payroll compensation from the business.  Count the owner(s), if they receive any compensation from the operation of the business. Do not count any contract positions.
Search by NAICS number or industry keyword

Part III. Assessment Questions


Please write-in your biggest perceived challenge for the upcoming year.


Does the small business entity currently have open and/or carry balances on any of the below credit products?
Open, Paid in Full Monthly Open, Pay Minimums Only Open, Pay More than Minimums Don't Have This Product
Open, Paid in Full Monthly Open, Pay Minimums Only Open, Pay More than Minimums Don't Have This Product

Does the small business currently utilize, or do you have a desire to learn about, any of the below skills and associated software?
Currently Utilize, Want to Learn More Don't Currently Utilize, Want to Learn More No Interest
Currently Utilize, Want to Learn More Don't Currently Utilize, Want to Learn More No Interest
Currently Utilize, Want to Learn More Don't Currently Utilize, Want to Learn More No Interest
Currently Utilize, Want to Learn More Don't Currently Utilize, Want to Learn More No Interest


Please indicate what types of financial assistance the small business has applied for, if any, within the last 12 months.
Approved Declined Did Not Apply
Approved Declined Did Not Apply