Small Business Legal Clinic - Interest Form
Thank you for your interest in the Small Business Legal Clinic (SBLC). Please fill out this survey completely and we will respond within three business days.

Important! We can only serve Oregon businesses and only work with transactional legal issues.

Information from this form is used for screening purposes only and will be used to determine your possible eligibility for SBLC services. Confidential or sensitive information should not be sent through this form. The information gathered here will not be used for any other purpose or shared without any outside organization or individual without additional authorization. Please see our privacy policy for additional information, https://law.lclark.edu/centers/small_business_legal_clinic/sblc-privacy-policy/

First Name: *
Your answer
Last Name *
Your answer
Business name *
Your answer
Address of business *
If there is no current business address, please put your personal address
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
County
(such as Multnomah or Clackamas)
Your answer
Telephone contact number *
Your answer
Contact E-mail *
Your answer
Business website
Your answer
Business location
Is the business currently registered in Oregon *
Required
If the business is registered, when was it registered?
MM
/
DD
/
YYYY
Type of business: *
How long has the business been operating? *
How many owners are in the business?
If you are a non-profit corporation, please choose other.
Adjusted Gross Personal Income for Owner # 1 - Please give the exact number, not an estimate. (See individual federal tax return - 1040, 1040A, 1040EZ). This is NOT the company income, but the household personal income of the owner. Do not include just a portion of the income. Please state the income for the entire household. *
If you are a non-profit corporation, please write your operating budget
Your answer
Adjusted Gross Income for Owner #2 (See household federal tax return - 1040, 1040A, 1040EZ) *
Required for each owner. Put in $0 if no second owner
Your answer
Adjusted Gross Income for Owner #3 (See household federal tax return - 1040, 1040A, 1040EZ) *
Required for each owner. Put in $0 if no third owner.
Your answer
Adjusted Gross Income for Owner #4 (See household federal tax return - 1040, 1040A, 1040EZ) *
Required for each owner. Put in $0 if no fourth owner.
Your answer
How did you learn about the Small Business Legal Clinic? *
Your answer
Information provided, submitted or transmitted through this form does not create an attorney-client relationship and cannot be used to preclude the SBLC from representing a client that may have a conflict of interest with you. The creation of an attorney-client relationship requires a written agreement that confirms that an attorney-client relationship has been established. *
When is a good time to contact you?
We will try to contact you at this time, but may need to call at another time depending on our schedules.
Your answer
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