Name *

First Name

Last Name

Phone *

(###)

###

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My organization is a:

Check all that apply

Start-up

Sole Proprietorship

LLC

LLP

Partnership

C-Corporation

S-Corporation

Non-Profit

Other

My goals for this organization include:

Check all that apply

Growth

Change

Restructuring

Down-sizing

'Right'-sizing (finding the 'sweet spot')

Simplifying

Maximizing retained income

Growing/Diversifying income streams

Reducing my expenses

Exit Strategy

Other - let's talk about this

In the next 12 months I will be:

Check all that apply

Hiring employees

Purchasing real estate

Purchasing equipment

Investing in new business technology

Revamping my website

Adding a partner or associate

Merging with another group

Separating from a partner or group

Other - let's talk about this

I don't have any big changes on the horizon

Services I may be interested in:

Check all that apply

Coaching

Consulting

Accounting/Bookkeeping

I'm not sure what I need yet

I have an accounting system in place:

Yes

No

My financial accounting and bookkeeping:

Is done by me

Is done in-house by my employee

Is done by my CPA

Is done by an external Bookkeeper

Is something I need help with

I operate using a budget:

Yes

Mine needs work

No, I wing it

I need one

I would like to learn more about what my financial statements mean and how to use them:

Yes

No

I have done a full review of my income and expenses in the past 12 months:

Yes

Somewhat

No

Would it be helpful to have a better understanding of how to make more money or how to save money on things you already purchase?:

Yes

No

I have a business plan:

Yes

Mine needs work

No

I need one

I have an organizational chart:

Yes

Mine needs work

No

I need one

I am in need of Capital Funding:

Now

In the next 12 months

In the next 36 months

Possibly someday

No, I'm good

I could really use:

Check all that apply

Someone to guide me and give me advice on how to navigate some specific things

A sounding board

Someone to help me do some things, but from a remote location

Someone to come to my location and help me do some things

Someone to help me figure out what way is best to work through some things

Nothing right now, I'm good

This best describes my situation:

I have a budget set aside for the services I need

I need help establishing a budget

I am seeking free advice at this time

I have worked with a consultant / coach before:

Yes

No