Coaching/seminar at your facility: 1 full day

Name

Positon

Email Address

Direct Phone Number

When filling out this form please be truthful and as complete as possible. Add any notes that would be important on the applicable line. Your answers will help us determine how to best help you and your company in the specific areas required. If you are not the company owner, you are not required to answer the personal questions.

1. COMPANY INFORMATION

Name of your company:

Address:

Website:

Main Phone Number:

Industry and primary purpose:

Number of employees:

Number of sub-contractors utilized:

Years in Business:

Company own or lease the premises:

Is there room for expansion:

2. FINANCES

Gross income last year:

Net profit last year:

Up or Down from previous 3 years:

What is the current financial state of your company?

Outstanding company loan amount:

Outstanding personal loan amount:

Projected income this year:

Outstanding IRS debt:

Outstanding payroll liabilities:

Any liens against the company:

Any judgements against the company:

Any pending lawsuits against the company:

3. MARKET

# of usual / repeat clients on file:

# of new clients last year:

# of new clients current year:

State of your company’s market:

Any recent change in the competition:

Future competition prediction:

Method of marketing used:

Effectiveness of marketing:

Public knowledge about your company:

Current client knowledge about your company:

Service primarily in niche market:

Client average rating of your company:

4. ADMINISTRATION / OPERATIONS

Efficiency of your company: Rate on scale from 1 to 10, 10 being the best

5

Personnel doing their job correctly: Rate on scale from 1 to 10, 10 being the best

5

Duties distributed effectively: Rate on scale from 1 to 10, 10 being the best

5

More personnel required: Rate on scale from 1 to 10, 10 being the best

5

Personnel changes required: Rate on scale from 1 to 10, 10 being the best

5

Technology in use: (Such as types of accounting, scheduling, estimating software)

Different / advanced systems available:

% of work outsourced:

% of work sub-contracted:

% of work performed in-house:

Do your clients generally have a positive experience with your company's products or services?

Is there anything you could do to improve your client’s experience?

5. COMMUNITY INVOLVEMENT

Community activities sponsored by company:

Employee volunteer activities:

Donations to charities:

Company memberships:

Political Affiliations: