Virtual Meeting Intake Form

Welcome! Please complete the following form to let us know how we can help you with your business needs. We require this form to be filled in for each consult you have, regardless if you have filled it in before. You be able to skip the majority of the questions if you have been here before. Once you have submitted the form you will receive a link to set up a virtual meeting. That link can be found at the bottom of your confirmation email. Please scroll to the bottom of the email so as to not miss the calendar link. *If you do not receive a message back, please check your SPAM folder.* Please note, this process is required to access our free services. Please be considerate, if you can no longer make your appointment, please follow up to cancel or reschedule. We may not be able to honour future appointments if you do not show up for 3 or more appointments as this time has been held for you and not been available for other clients. *Please also note: From October 3 - March 30 our business advisor will be accompanied by an intern. If you would like the intern not to be present, please email your advisor once you receive your confirmation email.

What's your first name?

What's your last name?

Would you like to share your pronouns?

i.e. she/her, he/him, they/them

What's the name of your business (or proposed business name)?

What's your preferred email address?

What's your primary phone number?

Have you been a client of the Stratford Perth Centre for Business before?

No
Yes, for this business
Yes, for another business

Street Address

City

Province

Postal Code

Please provide your Area or County.

Please let us know which area or County where you or your business reside. (i.e. Perth, Huron, etc.)

City of Stratford
Town of St. Marys
Perth County
North Perth
Perth South
Perth East
West Perth
Huron County
Oxford County
Waterloo County
Other

Do you have a website? If so, please provide the website URL below.

Type of Business

What was the date your business was or will be established?

If you don't know the exact date, please take a reasonable guess. If you don't have a business yet, you can leave this blank.

If your business is currently in operation, how many people are employed by the business including the owner/operator (you)?

Type of Business Service requested:

Select all that apply.

What are you hoping the Stratford Perth Centre for Business can help you with at this time?

{name}

How did you hear about us?

City of Stratford
investStratford
Perth CFDC
Facebook
instagram
Twitter
Google
Presentation/Outreach
Community Partner
Friend/Family
Other (please detail below)

Thank you for your time in completing this form. In an effort to be more intentional with our client care we invite you to indicate any of the groups you identify with below.

This information is used internally as we work to create more inclusive programming. In addition, aggregate statistics may be shared with our local and provincial partners as required. Completion of this section is completely voluntary and has no impact on the services available to you.

Gender Identity (e.g. woman, man, transgender, gender neutral, non-binary, agender, pangender genderqueer, two-spirit, etc.):

Ethno-Racial Background (e.g. Indigenous, First Nations, Métis, Inuk/Inuit, Black, East/Southeast Asian, Latino, Middle Eastern, South Asian, White, Multiracial/Biracial, etc.):

Disclaimer

By checking the box below, I give The Stratford Perth Centre for Business (consisting of the Stratford Economic Enterprise Development Corporation) permission to disclose my provided contact information between the above-noted entities and its funding partners (i.e. Provincial Ministry of Economic Development Job Creation and Trade) for the purpose of providing business consultation, economic development, financial assistance, and delivery feedback. The use of my provided contact information by the above is limited to the administration of the services and program data analysis as prescribed by the Stratford Perth Centre for Business and its funding partners and cannot be used for marketing or any other purpose.

Release

By checking the box below I confirm that I understand that I am solely responsible for the planning, implementation, financing, operation, success, and development of my business. Any advice or suggestions made are for my consideration and I am not bound to take any such advice or suggestions and can obtain advice and assistance from any source. I accept that any decisions pertaining to my business are my responsibility. I release the representatives of the Stratford Perth Centre for Business and the Stratford Economic Enterprise Development Company from any claim for loss or damages suffered by me or my business in connection with services provided.

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