NextLevel Business Solutions Assessment Form

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Completing this Assessment Form will help us to help you Elevate Your Business to Higher Levels of Performance, Revenue, and Profitability.
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Contact Name* This field is required.(Main Business Owner Only)
First Name
Last Name
3
Business Co-Owner's Name * This field is required.If there isn't a co-owner, input N/A
First Name
Last Name
4
Business Name* This field is required.
Incorporated Name
DBA Name
5
Business Website* This field is required.If you don't have a website, type N/A
6
Corporate Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Actual State of Incorporation* This field is required.
State
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Email Address* This field is required.(Business Owner's Direct Corporate Email Address)
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code? or
Receiving the email may take a few minutes, thank you for your patience!
9
Phone Number* This field is required.(Business)
Please enter a valid phone number.
10
Phone Number* This field is required.(Owner's Mobile)
Please enter a valid phone number.
11
How Long Have You Owned Your Business?* This field is required.
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Have you completely reported the ownership and management information of your business to the U.S. Treasury Financial Crimes Enforcement Network (FinCEN); regarding the Corporate Transparency Act (CTA) of 2024?* This field is required.Click Here, to access the application to begin the process of compliance, or access via our website.
YESNO
13
If you haven't, would you like for our corporate legal team to assist you in complying; to avoid a fine of $500/day and a Penalty of $10,000 or 2 years imprisonment?* This field is required.Click Here, to access the application to begin the process of compliance, or access via our website.
YESNO
14
What's your Specialty?Optional to receive referrals. We promote the business of our clients.
What's your specialty, to receive referrals?
15
In Need of a Business Loan? If so, what type of loan would you need?
Please Select
Please Select
Line of Credit
Quick Loan, up to $25K in 24hrs.
Fast Capital, up to $3M this week
SBA Business Loan
Expansion
To Meet Payroll
To Purchase or Lease Equipment
To Purchase Commercial Real Estate
Veteran-Owned Business Loan
Other
No Loan Needed at this time N/A
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What size loan do you need?If you don't need a loan, at this time, select N/A
Please Select
Please Select
Under $25,000
Under $349,999
$350,000 - $750,000
$751,000 - $1,250,000
$1,250,001 +
No Loan Needed N/A
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Have You Made Arrangements with anyone, to procure, up to $26K per Employee, for you, via the Employee Retention Credit (ERC) Program?* This field is required.
YESNO
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Would you like for us to assist you with obtaining up to $26K per Employee, via the ERC Program?* This field is required.
YESNO
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Does Your Business Currently Offer Consumer Financing?
YESNO
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Would You Like to Offer 100% Consumer Financing, Regardless of Credit, to Your Customers/Clients?* This field is required.Minimum loan amount is $1,000 up to $100,000
YESNO
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What is your Average Monthly Revenue, over the past three (3) Months?* This field is required.To determine eligibility, to provide 100% Consumer Financing regardless of credit.
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Does Your Business Need the services of an Experience Debt Collector to collect your Delinquent Debt?* This field is required.
YESNO
23
Does Your Business Need the services of an Experience Tax Specialist?* This field is required.
YESNO
24
Does Your Business Need Loan Servicing?* This field is required.
YESNO
25
Are you working with anyone regarding your Online Reputation and Reviews?* This field is required.
YESNO
26
Are you working with anyone regarding your Marketing and Advertising?* This field is required.
YESNO
27
How Many New Customers/Clients are you approximately Averaging, Daily?* This field is required.
28
How Many New Customers/Clients would you like to Average, Daily?* This field is required.
29
What is the Life time Value of a Customer/Client to your Business?* This field is required.
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Would you consider yourself to be detailed oriented?
YESNO
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What Distinct and Clear Advantage Does Your Business Have Over Your Competitors?* This field is required.List Your Unique Selling Proposition (USP)?
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What Would You Like to Improve in Your Business? Listing the Most Important first.* This field is required.
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What are Your Pain Points?* This field is required.
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Are you interested in becoming #1 in your market and dominating it?* This field is required.
YESNO
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Are you Currently Dominating Your Market?* This field is required.(Zip Code, City, County)
YESNO
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What are Your Three (3) Most Profitable Items/Packages * This field is required.(not cost; but, most profitable)?
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How Are You Currently Marketing and Advertising?* This field is required.
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Are you Currently working with some sort of a Marketing and/or Ad Agency?
YESNO
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How Much are you Currently Spending on Marketing and Advertising/Month? ($)* This field is required.
40
Do You Need More Space and/or Equipment?* This field is required.
YESNO
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Do You have a dedicated staff member handling your customer/client service?
YESNO
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How Many Customers/Clients do you have in Your Database? * This field is required.(Approximately)
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How Many Days Per Week, do you work in your Business?
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How Many Days per Week, would you Prefer to Work? Seriously?
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Select the Social Media Sites, in which your are currently active* This field is required.
LinkedIn
Facebook
Twitter
Instagram
Other
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What Are Your Realistic Short Term Goals?* This field is required.
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What Are Your Realistic Long Term Goals* This field is required.
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If you could wave a magic wand, today, what one skill, would you manifest in yourself that could be done with excellence, in your business, you feel would help you the most, to at least double your revenue? What skill would that be?* This field is required.
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What area of your business, would you like to see strengthen to achieve more Sales, Revenue, and Profitability?* This field is required.
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Are you currently using a CRM (Customer Relations Management) software system, in your business?* This field is required.
YESNO
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What software tools/technology are you using, to market your business and manage your customers/clients?* This field is required.
52
Who or What are you using to manage your Reputation; and are you happy with the results?* This field is required.
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Who or What are you using to drive traffic to your business website? Are you happy with the results?* This field is required.
54
Who or What are you using to Re-target traffic to your website; and are you happy with the results?* This field is required.
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What do you think it will take to Dominate and Become #1 in your Market?* This field is required.
56
Please verify that you are human* This field is required.
57
Thank you for completing this very necessary assessment form. Indeed, there were a lot of questions, but you will come to understand the WHY and necessity of them. We will assess and address your answers and needs, appropriately. Then we will schedule an online appointment, with you to discuss the best strategy to achieve the results you desire, for you and your business, moving forward.There's no better time, than now, to Elevate your business to NextLevel Status!
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