Small Business Financial Health Survey
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
About Your Business
Name of your business:
*
What year was your business established?
*
Where is your business located?
*
Business is based out of my home or virtual (all sales or services are done over the internet)
Business is mobile(services are provided in people's homes or moved from site to site, such as a food truck)
Business is located in a rented space
Business is located in an owned space
Which of the following BEST describes your business' primary activity
*
Professional Services (including Lawyers, Accountants, Engineers, Architects, Advertising and PR)
Business Support Services (including House Cleaning, Office Administration, Facilities, Landscaping, Security, Employment Services, Janitorial, Waste Collection)
Accommodation and Food Services (including Hotels, Restaurants, Caterers, Coffee Shops, Bars)
Retail Trade (including Retail Stores, Non-store and Online Retailers, Gas Stations, Motor Vehicle and Parts dealers)
Personal Services and Repair Services(including Hairstylists and Cosmetologists, Personal Trainers, Laundry Services, Repair and Maintenance)
Health Care and Child Care (including Nursing Services and Medical Assistants, Medical Technicians, Home Health Care, After-school Care, Educational and Tutoring Services)
Construction, Construction Managers and Workers, and Contractors
Wholesale Trade
Real Estate and Rental Services (including Real Estate Agents and Brokers, Rental Services)
Finance and Insurance
Manufacturing
Transportation, Warehousing, and Storage (including Postal/Courier Services, Moving Services, Taxi Services, Trucking)
Agriculture, Forestry, Fishing, Hunting, Mining, Quarrying, Oil and Gas Extraction
Other
Is the business your primary source of income?
*
Yes
No
Total Revenue/sales earned by the business last year:
*
$0 - $50,000
$50,001 - $150,000
$150,001 - $300,000
$300,001 - $500,000
$500,001 - $1,000,000
$1,000,001 - $5,000,000
Over $5,000,000
At the end of last year my business was:
*
Profitable
Break-even
Ran a deficit
How much did your business allow you to take home last year, in salary and distributions?
*
$0 - $50,000
$50,001 - $150,000
$150,001 - $300,000
$300,001 - $500,000
$500,001 - $1,000,000
$1,000,001 - $5,000,000
Over $5,000,000
Don't know
Financial Health
Over the past year, which of the following statements best describes how well your business is keeping up with its financial obligations? Please consider bills, taxes, payroll, and debt payments.
*
Pay all on time
Pay almost all on time
Pay most on time
Pay some on time
Pay very few on time
Generally, the business has cash available to cover:
*
Less than 1 month of operating expenses
1-3 months of operating expenses
4-6 months of operating expenses
7-12 months of operating expenses
More then 1 year of operating expenses
How would you describe the business' debt (including any personal debt you took on for the business)?
*
Does not have any debt
Has a manageable amount of debt
Has a bit more debt than it can manage
Has much more debt than it can manage
When is the last time you reviewed a profit and loss statement for the business?
*
In the last month
Over a month ago
Over 6 months ago
Over 12 months ago
Do not have a profit and loss statement
How would you rate your credit score? Your credit score is a number that tells lenders how risky or safe you are as a borrower.
*
Excellent
Very Good
Good
Fair
Poor
Don't know
Please indicate the extent to which you agree or disagree with the following statements.
I have access to affordable funding to meet my business goals. Please consider business profits, personal funds, and external funding such as debt or equity.
*
Strongly agree
Somewhat Agree
Somewhat Disagree
Strongly disagree
I have access to affordable, timely credit to meet my business needs.
*
Strongly agree
Somewhat Agree
Somewhat Disagree
Strongly disagree
I am confident that the business' insurance policies will provide enough support in case of an emergency. Please consider the coverage you have for vehicle(s), property, and liability insurance, if applicable.
*
Strongly agree
Somewhat Agree
Somewhat Disagree
Strongly disagree
I have a plan to address common business risks (new competition, loss of key personnel or customer, natural disaster damage, etc.)
*
Strongly agree
Somewhat Agree
Somewhat Disagree
Strongly disagree
I know how much money needs to come in and when in order to meet financial obligations.
*
Strongly agree
Somewhat Agree
Somewhat Disagree
Strongly disagree
I have a plan in case of: a cash shortfall due to late customer payments, or an emergency expense.
*
Strongly agree
Somewhat Agree
Somewhat Disagree
Strongly disagree
Other information about your business that you think will be helpful in our analysis.
Score (highest score is 49 and lowest score is 11)
Submit
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