Starter Company Plus Intake Form
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1
2Starter Company PLUS
Intake Form
Today’s Date: ________________________________
Have you been in for a consultation before?
What stage is your business at?
Yes
No
Planning
Est.______________
Are you taking part in any government grant programs or
If Yes:
ODSP
OW
receiving social assistance?
Yes
No
EI
Other: _______________________
Are you currently enrolled in any self-employment or entrepreneurship training/
Yes
No
financing programs offered by government funded organizations?
If yes: ____________
a
(Example: OSEB, Ontario Works Self Employment Program, Summer Company, OCE, Futurepreneur)
Are you currently working? (Outside
Are you currently attending school?
Yes
No
your business)
Yes
No
If Yes:
FT
PT
Are you planning to return to school?
Yes
No
What is your highest level of education?
High school
Some college/university
Degree/diploma/certificate
Are you:
Starting a new business
Expanding your existing business
Purchasing a business
Client Name:
Email Address:
Mailing Address:
Phone #:
City:
Postal Code:
Cell #:
Other Notes:
Date of Birth:
Age:
Business Name:
Business Mailing Address:
Phone #:
City:
Postal Code:
Cell #:
Website:
Business Start Date:
_______________________
Business Type:
Sole Proprietorship
Partnership
Incorporation
Business Sector:
Transporting &
Administrative &
Arts, Entertainment &
Agriculture, Forestry,
Warehousing
Support Services,
Recreation
Fishing & Hunting
Information & Cultural
Waste Management &
Accommodation & Food
Utilities
Real Estate, Rentals &
Remediation Services
Services
Construction
Leasing
Education
Other Services
Manufacturing
Professional, Scientific &
Health Care & Social
Unsure at this time
Wholesale Trade
Technical
Assistance
Retail Trade
Would you like to receive the SBEC eNewsletter?
Yes
No
How did you hear about Starter Company PLUS?
Word of Mouth (Referred by: __________________________)
Signage
Community Event
Print Ad
Website
Facebook
Other: ________________________
Description of Business (explain your products and/or services):
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Parent category: Business