BUSINESS CONSULTING CLIENT INTAKE FORM
Disclaimer: Thank you for your interest in being a client of FaGee Leadership 4 Excellency Ltd. This form is used to collect information about new clients for internal purposes only. The information you provided is confidential and will be treated accordingly as per the provisions of the Data Protection Act.
Date
-
Month
-
Day
Year
Date
Client Name
First Name
Last Name
Company name
Company number
E-mail address
example@example.com
Website
Phone Number
-
Area Code
Phone Number
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Industry Classification
Please Select
Retail
Food Service
Agriculture/Farming
E-Commerce
Not-for-profit
Association
Healthcare Services
Professional Services (legal, accounting, consulting, etc)
Financial Services
Business Services (advertising, printing, etc)
Technology/Telecom services
Construction/Maintenance
Manufacturing
Other
Please briefly describe your business or organisation needs.
Your role within the organisation:
Owner/Partner
Employee
Senior Manager
Advisor
Other
What kind of business consulting assistance do you need?
Please Select
Start-up planning, feasibility, etc
Business planning
Accounting, financial analysis
Business growth
Market strategy and research
Operations manager
Solving a problem or challenge
Promotion/advertising planning
Human resources management
Other
How long have you been in operation?
0-1 year
1-3 years
More than 3 years
What are your short-term financial objectives?
(e.g break-even, become profitable, achieve sales targets, etc)
Briefly describe your typical customer or the customer you would like to attract.
Why do you think you need a consultant and what results are you looking for?
Are there any specific deadlines or timelines we should be aware of.
How did you learn about us?
Word of mouth
Google/other search engine
Social Media
Other
Is there anything else you think we should know?
Additional Information
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Yes
No
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