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INFORMATION NOTICE OMB Approval No.:3245-0324

I request business counseling services from the West Business Development Center (West Center) and its Small Business Administration Resource Partners, Mendo-Lake SBDC, and the Mendocino Women’s Business Center. I agree to cooperate should I be selected to participate in surveys designed to evaluate services. I understand that any information disclosed will be held in strict confidence. (West Center will not provide your personal information to commercial entities.) I authorize the West Center to furnish relevant information to the assigned Business Advisor(s). I further understand that the advisor (s) agree not to:

1) recommend goods or services from sources in which he/she has an interest, and
2) accept fees or commissions developing from this counseling relationship.

In consideration of the Business Advisor(s) furnishing management or technical assistance, I waive all claims against SBA personnel, and that of its Resource Partners, host organizations, and West Center arising from this assistance.

By accepting these terms I agree, if selected, to participate in surveys designed to evaluate the services and impact of West Center and its SBA Resource Partners, Mendo-Lake SBDC, and the Mendocino Women’s Business Center. Any information disclosed in such surveys will be held in strict confidence.

Please note: You are not required to respond to any collection information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to: U.S. Small Business Administration, 409 3rd Street, SW, Washington, DC 20416, and to: Desk Officer SBA, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C., 20503. OMB Approval (3245-0324). PLEASE DO NOT SEND FORMS TO OMB.