Small Business Technology Survey

Name
First Last
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Section I: General Information/ Business Structure
1. Business Name
Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone
Please tell us your current and future Web goals. Include any details that you believe will help your business or organization.*
1. Is your business full-time or part-time?
Full Time Part Time
2. What is the form of business ownership? Please check one:
Individual (Sole Proprietorship) Parnership Corporation
3. Is the business woman-owned?
Yes No
4. What product or service does your business provide?
5. If we are able to offer a website development training and you are selected, would you commit to two hours per week for seven weeks to participate in a training module that enables you to build/enhance your website?
- Yes
- No

Section I: General Information/ Business Structure