Request for Consultation Form

Name:
Title: Company:
Phone/Fax: Email:
Please describe your issue/problem as specifically as possible:

Please select the type of counselor that you would like to meet with (please check one):
Accounting/CPA Advertising/Marketing Attorney Banking/Finance
Human Resources Insurance Investment Public Relations
Sales Strategy/Planning Technology Manufacturing
Other (please specify and we will try to find an appropriate expert)
In exchange for consulting services to be provided by the consultant as a part of the Business Consultation Program offered by the Broken Arrow Area Chamber of Commerce, I hereby agree to indemnify and hold harmless the Chamber and the consultant, their agents, employees, successors and assigns, from and against all damages, losses, costs and expenses, including attorney fees, which the member may incur by reason of advice received by the member from the consultant should the consultant or the Chamber be joined in any legal action brought against the member by any third party that may have directly or indirectly resulted from the consulting services received by the member from the consultant as part of the consulting services provided by the consultant to the member as part of the Chamber's Consultation Program.

Date:

By submitting this form, you are digitally signing this application.





Broken Arrow Area Chamber Website