Let Us Help You
Carolina Small Business offers a variety of financing, counseling, and technical assistance services to aspiring and current entrepreneurs. After you complete the form, our team of experts will assess your submission and reach out to see how we can best help. This form will take about 10 minutes to complete. 
NOTE: Please be advised that completing this form will supply preliminary details to assist your Business Solutions Officer in conducting a business assessment. It's important to note that this form is not a loan application.




How did you hear about us?


About You


"Enter the year from the tax return you used to report your adjusted gross income (YYYY)
Include yourself, your spouse (if applicable), and any dependents listed on your most recent tax return.
Enter the total adjusted gross income for your household from your most recent federal tax return
We're Here to Help
How can we help you?
At least one selection is required. What types of business counseling assistance are you interested in? Please select all that apply.


If selecting 'Business Needs Assessment,'  Here to access the form


Business Ownership


Enter 0 if you have no employees. Use numbers only.

Tracks whether you are participating in the NC Minority Business Development Association.
About Your Business
All field required. Please enter contact information for your business below. Please enter the EIN without dashes or spaces ("12345789" and not "12-3456789"). If this is a home-based business, enter the address for your personal business:
Enter EIN as one continuous 9-digit number, no dashes or spaces.
OUT OF SERVICE AREA  



Contract Based Financing





If the business entity normally receives bills at another address (for example, a PO box), select No.
Mailing Address
Business Primary Activity


Business Certification

Business Ownership
Business Structure

State of Formation








Personal and Business Finances
To better determine  your eligibility for small business financing, we need to ask a few additional questions. Please remember the information you share is confidential and will not be shared with any third party.
Credit Score Estimate

Available Collateral

Collateral Types


File Uploads

The following documents can help us more quickly provide the services you need. If you don't have a requested document, you can skip the question.

Demographic Information
We request that you provide the below demographic data to be in compliance with federal regulations. In addition, organizations which provide grant funding to us require that we ask some demographic questions not required by law. You must answer each question, but 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, federal regulations require that 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. 







Request for Services Submission
Signature required. Please read the below statements carefully. After you are done, sign on the next page with your mouse (if on a computer) or with your finger (if on a tablet or cell phone). By signing, you indicate you have read/agreed to the below and that all information you have provided is true and accurate to the best of your knowledge. 
Client Agreement
By submitting this form I am requesting business services from Carolina Small Business Development Fund (CSBDF) or one of its constituent programs. Some offices and programs of CSBDF are SBA Resource Partners, including the Western Women's Business Center (WWBC). If I receive services from the WWBC as a SBA Resource Partner, I agree to:

Cooperate should I be selected to participate in surveys designed to evaluate SBA services.
Allow my contact information to be released for purposes of SBA surveys and informational mailings regarding SBA products and services.
Authorize the release of information to the businesss services counselor(s) that will help with my request. 
Waive all claims against CSBDF and the WWBC that may arise from receiving assistance. 
Our Commitment
I understand that the CSBDF employees working on my request have agreed to: (1) not recommend goods or services from sources in which he/she has an interest, and (2) not accept fees or commissions developing from this counseling relationship.
Use of Information
I understand that the information I am submitting is subject to CSBDF's data privacy policy and any information disclosed will be held in strict confidence. Neither CSBDF nor its partners will provide your personal information to commercial entities without your explicit consent. I understand the information collected through is form is to help continuing improvement of business counseling programs, to ensure effective oversight and management of entrepreneurial development programs and grants, and to meet government reporting requirements.

Contact Information