Contact Us Form

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Name:*
Email Address:*
	Please Note: In order for us to respond, we must have your email address. Any and all information provided will be held in strict confidence by the SBDC.

Address:
City:
	State: Zip:

Phone: (include area code)

Please fill out this brief survey to help us better understand you and your company. (optional)

Do you currently own or run a business:
Yes No

If so, what type of business are you in:
Service/Retail Agriculture Manufacturing Transportation Other, please specify:

What Iowa county are you located in:

Which of these topics are you most interest in learning about:
Business Planning Human Resources Management Financing Your Venture Bookkeeping/Accounting Marketing Insurance/Legal Taxes Understanding Your Credit Computer Software/Technology Other, please specify:

Would you like to see classes offered in these topics?
Yes No

Which of the following times would you most likely attend a workshop or seminar:
9 - Noon 1 - 3 pm 3 - 6 pm 6 - 9 pm Other, please specify:

Would you like to recieve our electronic newsletter?
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What type of Internet connection do you have?
Less than 56K dial-up modem 56K Modem High speed connection

Do you have some immediate needs we can help with? (If yes, please specify in the comment box below)
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