Confidential Questionnaire

Fill out our Confidential Questionnaire.  We will contact you as soon as possible after we receive your inputs.  Thank you!

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Personal Data

Do you own your home?
Are you a veteran?

Education (high school, college, graduate degree)

Employment Data

What have you liked most about your past employment?

What have you liked least about your past employment?

Business Ownership Data

Have you or your family ever owned a business?
Which types of businesses have initial appeal to you? (Check all that apply)

Using a scale of 1 to 10 (with 10 being the highest level of interest, and 1 being the lowest), please rate your personal interest in the following areas:


Describe how much you would enjoy the following roles

 

Prospecting for new customers
Networking with local business groups
Hiring and firing employees
Consultative selling
Marketing and advertising your business
Managing and training employees
Providing service quotes or estimates
Being the administrator in the back office
Accounting and bookkeeping
What type of employee do you prefer to have in your business? (Check top choice)
How many employees would you prefer to have in your business? (Check top choice)
What skills and area of business management interests you the most? (Check all that apply)

Lifestyle Data

In what areas would you prefer to own and operate your business? (Please list city/state)

What do you want your role in the business to be? (Please check top choice)

Early years:
3-5 years later:

How would you rate the following?

What other people think about your choice of business
Making a meaningful contribution with your business:
Being able to grow additional units/larger territory:
How supportive is your family about starting a new business?

Financial Data

(Please use rough estimates. Do not include account numbers, etc.)

 

If additional funds are needed to start a business, are they available to you?
Do you have a source of income other than salary?
Assets
Liabilities
Do you plan to have a partner?
Do you plan to have investors?
Do you plan to have investors?

The following information is requested because any affirmative answers may have a direct bearing on your ability to obtain financing for starting a business. This is a critical factor in determining which companies may match with your criteria.

Have you or your spouse ever been involved in a personal or business bankruptcy?
Are you or your spouse currently under any type of criminal investigation?
Are you or your spouse subject to any civil judgments?
Have you or your spouse ever been convicted of a crime?
Are you or your spouse currently involved in any pending lawsuits?