Thank you for your interest in connecting with Grow Nebraska Women’s Business Center! Below you will see a prompt to “Bill Me”. Please Note: all services directly from the office of GNWBC is completely FREE! However, the system that we use will ask if you’d like to be billed. Respond yes to complete this application. Again – you will not be charged for becoming a client/member of GNWBC or for attending any of our facilitated training programs. No credit card information will be requested or required, and you’ll never be asked to provide any billing information for any of our in-house services. Thanks again! We look forward to connecting with you soon.

Step 1: Member Info

Step 2: Additional Info

Step 3: Primary Contact

Step 4: Billing Contact

Step 5: Membership Options

Step 1:

Member Info

Company Name *

Please add your company name.

Leave Blank

Phone *

Please add your company phone number.

Website *

Please add your company website.

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country * Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo (DRC) Costa Rica Côte d’Ivoire Croatia Cuba Czechia Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Ghana Greece Greenland Guatemala Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Laos Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, FYRO Malaysia Maldives Mali Malta Mexico Moldova Monaco Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Türkiye Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Venezuela Vietnam World Yemen

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City *

Please add your City.

State * Choose... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Please add your State.

State * Choose... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Please add your State.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1

Address line 2

Country Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo (DRC) Costa Rica Côte d’Ivoire Croatia Cuba Czechia Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Ghana Greece Greenland Guatemala Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Laos Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, FYRO Malaysia Maldives Mali Malta Mexico Moldova Monaco Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Türkiye Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Venezuela Vietnam World Yemen

City

State Choose... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

State * Choose... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Please add your State.

State

Postal Code

Social Network Addresses

LinkedIn

Facebook

Twitter

Instagram

Youtube

Pinterest

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Amazon

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Step 2:

Additional Info

Business Description (200 char max) *

Please add your company description.

Business Keywords * (enter a space between words)

Please add your business keywords.

Directory Category * Choose... Accommodations & Food Services Administrative & Support Advertising & Media Agriculture, Forestry, Fishing & Hunting Arts, Entertainment & Recreation Construction Education Services Finance & Insurance Health Care & Social Assistance Information Management of Companies & Enterprises Manufacturing Mining Other Services (except Public Administration) Professional, Scientific & Technical Services Public Administration Real Estate & Rental & Leasing Retail/Trade Snap & Boost Graduates Transportation & Warehousing Utilities Waste Management & Remediation Services Wholesale Trade

Please select a directory category.

Full-time Employees *

Please add your number of full-time employees.

Part-time Employees *

Please add your number of part-time employees.

Part 1: Client Request for Counseling

I request business counseling service from the Small Business Adminstrastion or/and SBA resource partner. I agree to cooperate should I be selected to participate in surveys designed to evaluate SBA services. I permit SBA or its agent the use of my name and address for SBA surveys and information, mailings regarding SBA products and services. * Choose... Yes No

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Preferred Date & Time for Appointment *

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Client Signature (Please type name) *

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Date *

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Part 2: Client Intake

Race * Choose... American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

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Ethnicity * Choose... Hispanic or Latino Not Hispanic or Latino

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Gender * Choose... Male Female

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Do you consider yourself a person with a disiablity? * Choose... Yes No

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Veteran Status * Choose... No military, Reserve, or National Guard service Veteran Service-Disabled Veteran Member of the Reserve Active Duty Member of the National Guard Spouse of Military Member

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Referred by? * Choose... SBA District Lender Business Owner SBA Website SBDC SCORE WBC VBOC Other Client Educational Institution Local Economic Development Offical Chamber of Commerce Magazine/Newspaper Word of Mouth Television/Radio Internet Other USEAC Boots to Business GROW Nebraska

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Are you currently in business? * Choose... Yes No

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If you are currently in business are you exporting? * Choose... Yes No Not in business

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Name of business *

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Type of Business * Choose... Mining Utilities Information Construction Retail Trade Manufacturing Finance & Insurance Wholesale Trade Public Adminstration Educational Services Real Estate & Rental & Leasing Health Care & Social Assistance Accommodation & Food Service Arts, Entertainment & Recreation Transportation & Warehousing Professional, Scientific & Technical Service Management of Companies & Enterprises Agriculture, Forestry, Fishing & Hunting Administrative & Support Waste Management & Remediation Service Other Service (Expect Public Administration)

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Business Ownership-What percentage of your business is male or female owned? *

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Date Business Started? *

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Do you conduct business online? * Choose... Yes No

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Are you a home based business? * Choose... Yes No

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Are you 8(a) certified? * Choose... Yes No

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Total No. of Employees (Full & Part Time) *

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For your most recent full business year, what were your Gross Revenues/Sales and Profits/Losses? *

Looks good!

Amount of your Gross Revenues/Sales related to exporting? *

Looks good!

What is the legal entity of your business? * Choose... Sole Proprietorship S-Corporation Corporation Partnership LLC Other

Looks good!

What is the nature of counseling you are seeking? (Choose primary category) * Choose... Start-up Assistance (How do I start a small business?) Business Plan Financing/Capital (such as applying for a loan, building equity capital) Managing a Business Human Resources/Managing Employees Customer Relations Business Accounting/Budget Cash Flow Management Tax Planning Marketing/Sales (promotion, market research, pricing, etc.) Government Contracting (including certifications) Franchising Buy/Sell Business Technology/Computers eCommerce (using the Internet to do business) Legal Issues (such as, Should I Incorporate?) International Trade Other

Looks good!

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Cell Phone *

Please add your cell phone number.

Fax

Email *

Please add a valid email.

Contact Preference

Email

Phone

Address

Same as Address in Step 1

Address line 1 *

Please add your address.

Address line 2

Country * Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo (DRC) Costa Rica Côte d’Ivoire Croatia Cuba Czechia Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Ghana Greece Greenland Guatemala Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Laos Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, FYRO Malaysia Maldives Mali Malta Mexico Moldova Monaco Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Türkiye Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Venezuela Vietnam World Yemen

Please add your country.

City *

Please add your City.

State * Choose... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Please add your State.

State * Choose... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Please add your State.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

LinkedIn

Facebook

Twitter

Instagram

Youtube

Pinterest

TikTok

Amazon

Shop Now!

Create Account

This Login is already in use

Login *

Please add your login username.

Password *

Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Cell Phone *

Please add your cell phone number.

Fax

Email *

Please add a valid email.

Contact Preference

Email

Phone

Address

Same as Primary Contact Address

Address line 1 *

Please add your address.

Address line 2

Country * Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo (DRC) Costa Rica Côte d’Ivoire Croatia Cuba Czechia Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Ghana Greece Greenland Guatemala Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Laos Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, FYRO Malaysia Maldives Mali Malta Mexico Moldova Monaco Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Türkiye Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Venezuela Vietnam World Yemen

Please add your country.

City *

Please add your City.

State * Choose... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Please add your State.

State * Choose... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Please add your State.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

LinkedIn

Facebook

Twitter

Instagram

Youtube

Pinterest

TikTok

Amazon

Shop Now!

Create Account

This Login is already in use

Login *

Please add your login username.

Password *

Please add your login password.

Step 5:

Comments/Questions

Payment Option

Bill Me

Please complete the Captcha

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