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2. Norristown Small Business Assistance Center

   The Norristown Small Business Assistance Center is a project of the Municipality of Norristown and is funded with Community Development Block Grant (CDBG) funds the Municipality receives from the U.S. Department of Housing and Urban Development (HUD). All clients receiving technical assistance need to be Low and Moderate Income as established by HUD. 

4. Intake form (PDF format)
   You may print out a PDF copy of this intake form and submit it through email, or at Municipal Hall at your convenience.
6. Self- Certification Form for Family Income
8. Name*
9. Email Address*
11. Address*
12. City*
13. State*
15. Zip Code*
17. Phone Number*
18. Fax Number
20. Race/Ethnicity
    -- Select One --WhiteBlackHispanicAsianAlaska NativePacific IslanderAmerican IndianOther

    Please select the option that best identifies your race or ethnicity.

22. HUD income requirements
    

    Please review this chart before proceeding to the next two questions.

24. Family Size
    -- Select One --12345678+
26. Family Income
    -- Select One --Up to $39,999Up to $49,999Up to $59,999Up to $69,999Up to $79,999Up to $89,999Up to $99,999Over $100,000
30. How would you describe your business?
    -- Select One --IdeaStartup
32. What type of business are you interested in starting?
    -- Select One --RetailFood/serviceWholesaleManufacturingConstructionOther
34. Please describe the type of business and your product/service:
36. Please describe the audience (target client/customer/market) for your business’s product/service:
38. Do you have a business plan (select one)?
    -- Select One --YesNo
40. Approximately how many hours are you willing to spend operating your business (select one)?
    -- Select One --1-89-1625-3232+
42. How can we help you?
    -- Select One --Business plan developmentLegal and licensing issuesMarketing and advertisingProduction capacity/efficiencyAccounting/loansTruck/cart fitout or purchasePrep/commissary spaceRestaurant space
44. Income Verification

    I certify that this income information is correct and I understand that the information I have provided on my family income is subject to verification by authorized representatives of the Municipality of Norristown and the United States Department of Housing and Urban Development.

    (NSBAC on behalf of the Municipality of Norristown, reserves the right to request additional documents to verify household information; e.g., W-2. By signing this form, you are agreeing to produce documentation as requested to verify household income.)

    Persons with a disability who wish to receive technical assistance, and require an auxiliary aid, service or other accommodation must call please call (610) 277-1085.

46. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
48. Date
    Date
49. Electronic Signature
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

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