Get Client Intake Form (641) - Wordpress.com

Filling out the Client Intake Form (641) is an important step to access counseling and assistance from the U.S. Small Business Administration. This guide provides clear instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the Client Intake Form effectively.

1. Press the ‘Get Form’ button to obtain the form and open it in your browser.
2. Begin by entering the name of the office providing the service in the designated field.
3. Fill out the city and state of the office location.
4. Input your client number and location code if applicable, along with the initials of the data inputter.
5. Indicate your preferred method of counseling: face-to-face, online, or telephone.
6. In Part I, provide your name as the client, including last name, first name, and middle initial.
7. Add your primary and secondary telephone numbers as well as your email address.
8. Input your street address or P.O. Box, followed by your city, state, and zip code.
9. Express your request for business counseling services by confirming your consent to participate in surveys and sharing your information with a counselor.
10. Indicate your preferred date and time for the appointment.
11. Sign the form by typing your name and entering the date.
12. Proceed to Part II, where you will fill out demographic information including race, ethnicity, gender, and whether you consider yourself a person with a disability.
13. Provide information about your veteran status and referral source, marking all that apply.
14. Indicate if you are currently in business and whether you are exporting.
15. Complete business-related fields, including the business name, type, ownership percentages, and total number of employees.
16. Detail your revenue figures, nature of counseling needed, and any specific assistance requested.
17. Once the form is fully completed, save your changes, and you may choose to download, print, or share it as needed.

Complete your Client Intake Form (641) online to begin your journey towards obtaining the business support you need.