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Small Business Request for Assistance

  1. Instructions

    Please fill out this form as completely as possible, and sign and date the bottom of the form.

  2. Are you a veteran or active duty military?
  3. Business Stage
  4. How did you find out about us?
  5. Would you like to sign up for our small business email newsletter?
  6. Applicant Must Sign and Date

    I request business assistance from the City of Durham in identifying entrepreneurial support agencies to provide technical assistance and counseling to my small business entity. I authorize the City of Durham to furnish relevant information to the referred support agencies and their small business counselor(s), although I expect that information to be held in strict confidence.

    The City of Durham will not accept fees or commissions developing from this counseling relationship. In consideration of furnishing management or technical assistance, I waive all claims against the City of Durham, entrepreneurial support agencies, and any other resource counselors arising from this assistance.

  7. Leave This Blank:

  8. This field is not part of the form submission.