| Date |
| Name
Title |
| Name of Company |
| Street Address |
| City/State/Zip |
| Telephone No.
Fax:
e-mail: |
|
| Type of Business: [ ] Service
[ ] Manufacturing [
] Retail [ ] Wholesale
[ ] Other: |
| Type of Industry: |
|
Business Structure: [ ] Sole
Proprietorship [ ] Partnership
[ ] Corporation [
] Limited Liability Co.
[ ] Subchapter S Corp.
[ ] Other: |
|
What are your main concerns? [
] Business Management [ ] Marketing
[ ] Sales
[ ] Profitability
[ ] Finances [ ] Planning
[ ] Vision/ Goal Setting [
] Operations
[ ] Recruiting/ Hiring
[ ] Employee Development [
] Employ Turnover
[ ] Stress from the Business
[ ] Organization/ Orderliness [
] Customer Service/ Complaints
[ ] Not Enough Time to Get It All Done
[ ] Not Taking Regular Vacations [
] Productivity
[ ] Supervision [
] Team Building [ ] Selling My Business
[ ] Other: |
|
| How many employees do you have? |
|
| What year was your business established? |
|
What is your annual gross sales/revenue? [
] Under $100,000 [ ] $100,000 to $399,999
[ ] $400,000 to $999,999
[ ] $1,000,000 to $1,999,999 [
] $2,000,000 to $2,999,999
[ ] $3,000,000 to $3,999,999
[ ] $4,000,000 to $4,999,999 [
] Over $5,000,000 [ ] Prefer not to
say at this time |
|
| Would you like a business needs analysis? (There
is no charge) [ ] Yes |
|
| Would you like us to send you our catalog of products,
services, and fees? (There is no charge) [
] Yes |
|
| Would you like a brief consultation by phone?
(There is no charge for the first consultation) [
] Yes |
| Would you like an application to enroll in the Business
Development Program? [ ] Yes |
