Repeat Client Counseling Request

For Office Use Only
Date Received ___________________
Date Called ___________________
Appt. Date ___________________

Repeat Client Counseling Request Form

This form must be completed and turned in to the Fort Collins SBDC prior to your scheduled counseling appointment. The infomation is used to help the consultant prepare for your session.. Please print this completed form and bring it to the Fort Collins SBDC or fax it to (970) 498-8924 prior to your appointment. After submission of this form, you will be contacted to schedule an appointment with a consultant.

Client Name:               Address:

Business Name:        Phone:

Describe specific assistance requested

Have you hired any new employees since your last appointment?             Yes   No

If yes, how many?

Have you had to let go of any employees since your last appointment?   Yes   No

How many employees do you currently have including yourself?

Have you received any financing since your last appointment?                 Yes   No

If yes, how much and from whom
(Please include, private investors, owner investment, SBA, Banks, etc.)

Have you received any government or commercial contracts since your last appointment?
Yes No

If yes, what was the amount of contracts you were awarded?

Please share any other successes you have had since your last appointment: