Nebraska Business Development Center
 


Sign Up for Services


Thank you for your interest in our program's services. Please select a center nearest to your location and a representative will contact you shortly upon completion of this form.
Please select your nearest center
All mandatory fields appear in bold.
First:
MI: Last:
Street Address:
City: State:
Zip Code:
 
Home Phone: Work Phone:
E-mail: Fax Number:
Yes, I would like to be included in future center mailings.
Please complete the following fields so that we may better serve you in the future. All information provided here will remain confidential.
Gender: Race:
Hispanic: Veteran:
Reservist: Disabled:
Company Status: Business Type:
Briefly describe your current or proposed company's products/services:

Please complete the following details about your company.
Company Name: Date Established:
Organization Type:
Company Gender: Company Veteran Status:
Full-Time Employees: Part-Time Employees:
Business Online? Home-based Business?
Company Web Site:
Referral From: Assistance Requested:      
Please describe specific assistance requested:
PLEASE READ THIS STATEMENT, THEN SIGN AND DATE THIS FORM

I request management assistance from the Small Business Administration and/or the Nebraska Business Development Center (NBDC). I understand this assistance is free of charge. I agree to cooperate should I be selected to participate in surveys designed to evaluate SBA/NBDC assistance services. I understand that any information received by SBA/NBDC resource partner consultant(s) will be held in strict confidence by the consultant(s) to the extent allowed by law. I authorize the SBA/NBDC to furnish information to the assigned management consultant(s).

I further understand that SBA/NBDC resource partner consultant(s) have agreed: (1) not to recommend goods or services from sources in which he/she has an interest, and (2) will not accept fees or commissions developing from this consulting relationship. In consideration of SBA/NBDC furnishing management or technical assistance, agree to waive all claims rising against SBA/NBDC personnel and its host organizations arising from this assistance.
Please provide your full name (First, Middle, Last) indicating your acceptance to the terms shown above.
Date: