Request for Business Assistance

2. 
4. Last Name*
5. First Name*
7. Business Name*
   Enter the business name
9. Business Address*
11. City*
12. State*
13. ZIP*
15. Work Phone*
    Enter Work Phone Number
16. Secondary Phone
    Enter Secondary Phone
17. E-mail*
    Email address
19. Referred By

    Mark all that apply:

    1. County Office
    2. State Office
    3. Chamber of Commerce
    4. SBDC

    1. Lender
    2. Internet
    3. Business Owner
    4. SCORE

    1. Local Economic Development Official
    2. Media
    3. Other
21. Are you currently in business?

    1. Yes
    2. No
22. Date business started
    Date business started
24. Are you a home-based business?

    1. Yes
    2. No
25. Total Number of Employees
    (Full/Part-time)
27. What is the nature of the assistance you are seeking?

    (Choose a primary Category)

    1. Covid-19-Related Assistance
    2. Business Cunsulting

    1. Startup assistance
    2. Business Plan Development

    1. Financing/Capital
    2. Marketing/Sales
29. Describe specific assistance requested in the space provided.
31. As a business owner and/or resident of Cape May County, New Jersey you have a right to expect prompt, courteous, and professional assistance and services related to your economic and business development questions, inquiries and needs. We will be reaching out to you as soon as possible.
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field