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U.S. Small Business Administration

Counseling Information Form

The Florida Women’s Business Center is funded in part through a grant from the SBA. A requirement of providing free to low cost services is that each individual receiving services completes and signs a 641 form. By completing this form, you are giving permission for us to interact and/or communicate with you while maintaining confidentiality. Your information is not shared.
  • Download the Mandatory Counseling Authorization Form (SBA 641) from the link below and submit using the SBA submission form.
SBA 641 Form

Fill out, sign, and date the Counseling Authorization form (SBA 641)

If you are unable to sign, please type your name in the client signature field and click the use type name as signature checkbox field.

Your signature on the SBA 641 form provides permission to the FLWBC to discuss all aspects of your business while maintaining confidentiality. We cannot counsel or discuss aspects of your idea or business without a completed form.

SBA 641 Submission Form

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