New Customer Registration Form

Confidential Questionnaire

Begin your business ownership journey
Personal Information:

We appreciate your interest in our business ownership coaching services. We offer both consulting and coaching services to assist you in your journey towards successful business ownership. Please share with us some basic information so we can customize a plan to best assist you. All information is kept strictly confidential.
Full Name*

First NameLast Name
Partner Full Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Tell us about you, your family, and what you want to accomplish:
Tell us about you and the type of business that you think fits you best:
Business Ownership Data:

Understanding your business ownership experience as well as your new business desires, will help us to understand your goals, experience, capabilities, and business ownership desires. We look forward to helping you with your business ownership goals.
Have you ever owned a business before?*

YesNo
if applicable, please tell us about your business ownership experience:
How long have you considered business ownership?
What is your "why" behind wanting to be a business owner?
What are your business ownership goals?
Do you already have a business plan or an idea for a business?
Which Types of businesses have initial appeal to you?

RetailIndustrialHome BasedPersonal ServicesMobileFoodConsumer ProductsSenior CareFitnessBusiness to BusinessOther

Type a question

	Not Interested	Somewhat Interested	Very Interested
Mechanical / Automotive
Landscaping
Beauty / Fashion
Home Improvement
Working Outdoors
Real Estate
Working with Kids
Organizing Things
Pets / Animals
Fitness & Sports
Coaching / Teaching
Healthy Lifestyle
Computers / Hi Tech
Working with hands or tools
Working with numbers
Organizing things
Organizing people
Design / Decor
Entertaining
Travel & Leisure
Talking with People
Volunteering
Working with Seniors
Networking
Food

Are you interested in having employees? if so, how many?
Financial Information:

Your financial plans will directly impact the types of businesses or franchises that are available for you to acquire or start. The following information will guide the research and analysis we do to assist you. All information will be kept strictly confidential.
How much are you looking to invest?
What is your ~credit score?
What is your level of liquidity?
What is your ~ net worth?
Will you be partnering with another person? If so, please explain:
When are you hoping to make a decision on a business?

MonthDayYear
Date
Please provide any additional financial information that would be applicable in understanding how you will support or finance a business:
Career and Education Information:

Starting a successful business or franchise requires a great match with your background, experience and style as much as your financial goals and ownership dreams. Share with us a little more information to help us identify the ideal business match.
Highest level of education
Please tell us about your career experience:
Tell us about your management style and how you like to work:
Working with Refined Harmony

We are here to help you find, prepare, acquire, build, or grow your new business. We have experience assisting many new and experienced entrepreneurs achieve their dreams of owning and running a business. Let's spend some time in a free consultation to see how we can best help you achieve your goals.
Share with us how we can best assist you:
What services interest you the most?

Finding the right businessNavigating the world of franchisingEvaluating a new businessMarket analysisEntrepreneur coachingBusiness PlansNew Business StrategyOther
How should we contact you?*
Do you consent and agree to the Terms and Privacy Policy (located at the bottom of the page) and consent to receive notices and other communications (including through automated means) via telephone, mobile device (including SMS and MMS) and/or email?*

YesNo
Privacy Policy: At Refined Harmony LLC, no peronal information, including mobile information will be shared with third parties / affiliates for marketing/promotional purposes. All other categories exclude text messaging originiator opt-in data and consent; this information will not be shared with any third parties.
Please verify that you are human*
Should be Empty:

Confidential Questionnaire

Personal Information:

Business Ownership Data:

Financial Information:

Career and Education Information:

Working with Refined Harmony