*Email Address:  
Your email address will be used to gain access to the online BOSS training.
*First Name:  
*Last Name:  
Positition / Title:
Business Name:
Address: Business Phone:  
City: Home Phone:  
State: Business Fax:  
*Zip:    Other Phone:  

Race: 
Ethnicity: 
Gender: 
Disability: 
Military Status: 
Business Status: 
  **If Existing business status, please select start date:  
Type of business: 
Business Ownership: 
Business Online: 
Home Based Business: 
Business Organization: 

Number of Full-Time employees 
(including yourself): 
Number of Part-Time employees 
(including yourself): 
Estimated Annual Sales 
(Revenue): 
Estimated Annual Profit / Losses: 
Do you Export?  Do you Import? 
Is this a new product or technology?  Is your business defense related? 
*I Agree to the Terms: *Date:  

                 
 

SBDC at Ohio University, 19 E. Circle Drive, The Ridges, Suite 110, Athens, Ohio 45701 · 740–593-1797
The Ohio Small Business Development Center Program of Ohio (SBDC) program is funded in part through a cooperative agreement with the U.S. Small Business   Administration. The SBDC program is also funded in part by the Ohio Development Services Agency. All opinions, conclusions or recommendations expressed are     those of the author(s) and do not necessarily reflect the views of the SBA. Reasonable accommodations for persons with disabilities will be made if requested at   least two weeks in advance. Contact (name, address, and phone number of person who will make the arrangements).

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