Business Information Questionnaire
All information is secured and treated as confidential.
What Agent Are You Working With?
Business Name
*
Formation Date
*
-
Month
-
Day
Year
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Tax Filing Status
*
LLC
S-Corp
C-Corp
Other
Goals & Objectives
Do you have specific SHORT TERM FINANCIAL objectives?
*
Do you have specific MID TERM FINANCIAL objectives?
*
Do you have specific LONG TERM FINANCIAL objectives?
*
Do you have specific BUSINESS objectives?
*
Key Personnel
Please List Your Mission Critical (Key) Employees
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Business Financial Questionnaire
All information is secured and treated as confidential.
Debt & Expense Management
Monthly Operating Expenses
*
Do you keep an active P&L and Balance Sheet?
*
Yes
No
Do you have an emergency fund?
*
Yes
No
Do you have any major debts?
*
Yes
No
Debt Details
Income & Savings
Monthly Gross Revenue
*
Do you currently have any savings or working capital?
*
Yes
No
Amount
Do you, as an owner, have systematic savings?
*
Yes
No
Amount
Frequency of Deposit
What is the purpose of these savings?
i.e. Long Term, Short Term, etc
Taxes
Has your business filed taxes before?
*
Yes
No
What did you pay in annual tax over the last 3 years?
Rows
Estimated Annual Tax ($)
2022 Tax Year
2021 Tax Year
2020 Tax Year
Upload your last 3 years of tax returns
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If you could pay less tax, would you?
*
Yes
No
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Business Insurance Questionnaire
All information is secured and treated as confidential.
Do you and your partners have Buy / Sell Insurance?
*
Yes
No
Qualified Plans
Do you have a 401(k) plan?
*
Yes
No
Does your company provide any other types of Retirement Savings Accounts?
*
Yes
No
Please List Types
Does your company offer any type of executive bonuses or ownership deferrals?
*
Yes
No
Please List Types
Would you put in more money if you could?
Yes
No
How Much?
Group Benefits
Do you feel that your company has adequate insurance coverage, including life, health, and disability, at the right price?
*
Yes
No
When was the last time you reviewed your policies?
*
Do you provide group life insurance?
*
Yes
No
Type of Life Insurance (Select All That Apply)
Permanent Life
Variable
Term
Please upload policies and statements for your Life Insurance
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Do your key employees have life insurance?
*
Yes
No
Total Amount
Do you provide health insurance?
*
Yes
No
Why not?
Do you have liability insurance (or D&O, E&O) for Owners?
*
Yes
No
Why not?
Do you have liability insurance (or E&O) for Key Employees?
*
Yes
No
Why not?
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