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Small Business Technical Assistance Intake Form

Please fill out this form completely and accurately as the grant funding needed to provide support depends, in part, upon collecting this information. If you have any questions please email Emmalyn@cdcsb.org.

Owner Information
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

If different from mailing address.
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Please only put in numbers. Do not include any symbols (Ex. $ or ,)
Business Information
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
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Check all that apply.
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If you selected more than one category above please prioritize what type of help would be most beneficial.

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I understand that the information given in this application will be used to determine eligibility for services provided by the Community Development Corporation of South Berkshire Small Business Technical Assistance Program and will be treated as confidential. The information provided in this application has been given freely and is true to the best of my knowledge. I affirm that I am the owner of the business or prospective business receiving technical assistance. My agreement affirms that I will not hold the Community Development Corporation of South Berkshire, or its' representatives, liable for business outcomes based on counseling, training, or teaching I receive.