The Confidential Questionnaire

Confidential Questionnaire

Your information is important in the process to uncover several options that will make sense for you to review -- therefore, please submit your information thoughtfully and thoroughly. This questionnaire and its contents will NOT be shared with anyone without your permission.
"Go By" Name*

Example: My name is David but I "go by" Dave.Last Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
How many years have you lived at this address?
Phone Number*
Please enter a valid phone number at which I may contact you during the day.
Best time to call?*

Children still living with you? If so, how many?
Example: Two children ages 10 and 12
Do you have partner(s), adult children and/or relatives with whom you would involve in your business?
Relationships and ages - Example: My 30-year old son ... My brother-in-law ... my current business partner
Your current or most recent occupation?
Your current or most recent yearly income exclusive of retirement income.
Your yearly retirement income, if any.
Your spouse or significant other's occupation?
Your spouse or significant other's current or most recent annual income, exclusive of retirement income.
Your spouse's or significant other's yearly retirement income, if any.
Have you ever owned a business? If so, what type and/or industry?
How long have you been looking for a business?

Just startedOver the last few monthsFor more than a year
Why are you looking for a business now?
Examples: "Dislike my job" ... "More security" ... "Better income" ... "I've always wanted my own business" ... etc.
What types or names of businesses and/or franchises have you investigated so far?
What most interested you in the businesses/franchises you've investigated?
What's your timeframe for starting a new business?

As soon as possible3 to 6 months from nowWithin a yearI'm just looking at options with no timeline
Who will make the final decision to invest in a new business?

I willMy spouse/significant other and I willMy partner(s) and I willOther
In what citiy(ies) or market(s) do you wish to open a new business?

How do you rank your level of interest in owning a business in the following categories?

	Not Interested	Somewhat Interested	Interested	Very Interested
Automobile services and after-market products, oil change, painting
Pets & Animals - pet supplies, kenneling, training
Home Design & Decor - window coverings (blinds/curtains), flooring
Caregiver - in-home senior care, transportation, daycare
Fitness/Sports/Healthy - Gyms, cycling, Pilates, Yoga, stretching
Education/Teaching - tutoring, private school, after school programs
Barber shop, beauty shop
Home Improvment - kitchen/bath remodeling, garage/closet customization
Information Technology Services
Dry Cleaning/Laundry, laundramat
Professional Services - Business Coaching
Fast Food, Fast Casual, Full Service w/ Bar Restaurants - Catering
Real Estate Inspection Services
Property Management Services - Vacation Rental Management
Business and/or Presonal Accounting & Tax Services
Senior Services (Home/bath Modifications or Nursing Home Placement)
Medical Services - Regenerative services, IV infusion treatments
Human Resources Services to Businesses
Employment Placement Services
Services/Products for the Construction Industry - Trash removal, portable toilets, storage units
Clothing Sales (Resale, Boutique, etc.)
Womens' Services - Spa/Massage Services, Hair, Nails, Lashes, Skin Care
Building Maintenance Services - Cleaning, maid services, painting, power washing, HVAC, pool maintenance, landscape
Drug Testing
Light Manufacturing
Fire/Water Damage Mitigation
Weight Loss Services
Handyman Services
Home/Business Improvement - siding, roofing, gutters, insulation

How do you rank your level of skill/experience in the following categories?

	No experience	Somewhat Experienced	Sufficently Experienced	Very Experienced
Working with numbers (budgeting, accounting, forecasting)
Sales
Employee Management
Organizational/HR
Operations Management
Supply Chain Management
Information Technology
Organizational Leadership
Executive Experience (VP and/or C-Suite)

How would you rank your level of interest in the following types of businesses?

	Not Interested	Somewhat Interested	Interested	Very Interested
Retail - Strip Center
Retail - Stand alone
Home Based
Mobile/Van-Based
Leave my job and work in my business full time
Keep my job and open a semi-absentee; manager-run business
Transition from full time to semi-absentee over time
Business-to-Business Services/Products
Business-to-Consumer Services/Products
Business Services - marketing, printing, mailing, copying, signs

What liquid resources (cash, stocks/bonds, 401(k), non-Roth IRA, TSP) do you have available?

$20K - $30K$30K - $50K$50K - $75K$75K - $100KMore than $100K
What is your approximate net worth (all you own minus all you owe)?

$100K or Less$100K - $200K$200K - $300K$300K - $400KMore than $400K
Thank you for submitting your Confidential Questionnaire. I appreciate the time and care you gave to submit this important information.
Please verify that you are human*
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