Gateway to Entrepreneurial Tomorrows: Let's Get Started

	address_top Locations Across The Mid Hudson Valley Region: 845.790.5004 \| 845.787.4328 Headquarters: 280 Broadway, Newburgh, NY info@gethudsonvalley.org
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BUSINESS INFORMATION (if applicable)
Request For Services PARTICIPANT'S CONTACT INFORMATION
Name:
Email:
Mailing Address:
City:
State:	Zip:
Phone:
Business Name:
Business Phone:	Fax:
Type of Business:
Web Address:
Business Start Date: (or projected start date)
STATISTICAL DATA
How did you hear about our program?
Ethnic Origin:
PERSONAL INFORMATION
Describe the type of business you have or want to start:

Do you have any experience regarding this type of business? If so, explain:

Do you have a support system to encourage or assist you on your path to entrepreneurship? (Family, Friends, etc.):

Are you currently employed outside of your business? If so, what availability do you have to work on your project?:

Will you need to seek financing for your project?:

Is there any information we should know to better assist you with your project?:


By submitting this information I agree to the following: I/We understand that Gateway to Entreprenurial Tomorrows (GET) is a free service and all information I/We give is deemed to be confidential in nature. I/We also understand that GET and its employees are not responsible for the outcome of the serviced provided. No results are implied and/or guaranteed. Final responsibility rests solely with the person/s requesting and using the service.

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Headquarters: 280 Broadway, P.O. Box 1387 | Newburgh, NY 12551 | 845.787.4328

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