Business Owner Interview Consent Form
Please complete this form to provide your consent and share your interview preferences for our business research.
Full Name
*
First Name
Last Name
Business Name
*
Role/Title
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Interview Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Preferred Interview Format
*
In-person
Phone
Video call
Other
Topics You Are Comfortable Discussing
*
Business background and history
Products and services
Market and customers
Challenges and opportunities
Future plans
Other
Consent Statement
I acknowledge and consent to participate in this interview, and give permission for the interview to be recorded, for notes to be taken, and for quotes or summaries to be used solely for the stated business research purpose.
*
I agree
Type your full name as your signature
*
Date of Consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: