Call :

(715) 254-2267

Location :

PO Box 296 Eagle River, WI 54521

Confidential Questionnaire

First Name*

Last Name

Age*

Spouse First Name*

Last Name

Age*

Home address*

How long*

City*

State*

Zip Code*

Do you own your home? *

Yes

Are you a veteran?*

Yes

Home Phone*

Cell Phone*

Work Phone*

Best time to call*

Your Email*

Spouse’s email

Names and ages of children/dependents *

Education (high school, college, graduate degree)

You*

Spouse*

Please list your hobbies and special interests

Current position*

Spouse’s current position*

Employer*

Spouse’s employer*

Duties*

Spouse’s Duties*

Annual Income*

Spouse’s Annual Income*

Why are you considering a change from your employment at this time?*

What have you liked most about your past employment?*

What have you liked least about your past employment?*

Have you or your family ever owned a business? *

Yes

If yes, please describe the business and details

How long have you been looking for a business?*

What attracts you to owning your own business?*

Are you seeking an individual franchise or multiple units?*

What other businesses have you investigated?*

What are your strengths related to managing a business?*

What are your weaknesses related to managing a business?*

What are your major concerns about business ownership?*

Retail

Home based

Office based

Mobile

Personal services

Fast food

Other food

Consumer products

Business to business

Mechanical/Automotive:

Landscaping:

Beauty/Fashion:

Remodeling/Home Improvement:

Working Outdoors:

Real Estate Buying or Selling:

Working with Children:

Organizing Things:

Pets & Animals:

Fitness & Sports:

Coaching or Teaching:

Having a Healthy Lifestyle:

Computer/High Tech:

Working with Hands and Tools:

Working with Numbers:

Organizing People:

ODesign & Decor:

Being around Cars/Motorcycles:

Entertainment or Dining or Hosting Parties:

Travel & Leisure:

Talking with just about Anyone:

Volunteering/Getting involved in Community:

Working with Seniors:

Networking with People:

Prospecting for new customers*

High

Medium

Low

Consultative selling*

High

Medium

Low

Providing service quotes or estimates *

High

Medium

Low

Marketing and advertising your business*

High

Medium

Low

Networking with local business groups*

High

Medium

Low

Being the administrator in the back office*

High

Medium

Low

Hiring and firing employees*

High

Medium

Low

Managing and training employees*

High

Medium

Low

Accounting and bookkeeping*

High

Medium

Low

What type of employee do you prefer to have in your business? (Check top choice)*

White Collar

Blue Collar

Skilled

Unskilled

Don’t Care

How many employees would you prefer to have in your business? (Check top choice)*

None

Less than 5

5-10

10 or more

Don’t Care

What skills and area of business management interests you the most? (Check all that apply)*

Daily Operations

Selling

Managing Employees

General Management

Consulting

Marketing

Advertising

Finance/Bookkeeping

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

When would you like to start your new business?*

Would you be involved on a full-time or part-time basis?*

What hours of the day or week do you prefer to work?*

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

Early years:

Very Active

Full-time

Part-time

Passive

3-5 years later:

Very Active

Full-time

Part-time

Passive

How would you rate the following?*

What other people think about your choice of business:

High

Medium

Low

Being able to grow additional units/larger territory:

High

Medium

Low

Making a meaningful contribution with your business:

High

Medium

Low

How supportive is your family about starting a new business?*

Excellent

Average

Poor

Total liquid cash available for investment in a business*

Total Investment Range*

If additional funds are needed to start a business, are they available to you?*

Yes

Explain*

Do you have a source of income other than salary?*

Yes

Explain*

How will you cover your living expenses as you build the business?*

Assets

Cash (checking account):

Savings:

Stocks, bonds, securities:

IRA’s:

401(k)’s:

Primary home (market value):

Other real estate (market value):

Autos (market value):

Money due you:

Other assets (describe below):

Total assets:

Liabilities

Total balance of credit card debt:

Total balance of auto loans:

Student loans:

Primary home mortgage balance:

Second mortgage balance:

Other real estate debt:

Home equity line of credit:

Other debts (describe below):

Total liabilities:

Do you plan to have a partner?*

Yes

Do you plan to have investors?*

Yes

Will either your partner or investor be active in the business?*

Yes

Have you or your spouse ever been involved in a personal or business bankruptcy?*

Yes

Have you or your spouse ever been convicted of a crime?*

Yes

Are you or your spouse currently under any type of criminal investigation?*

Yes

Are you or your spouse currently involved in any pending lawsuits?*

Yes

Are you or your spouse subject to any civil judgments?*

Yes