Business Assessment Form
Participant Name
*
First Name
Last Name
Suffix
Participant Role
*
e.g. Chief Executive Officer (CEO), Partner, Vice President, Founder, etc.
Participant Email
*
example@example.com
Participant Phone Number
*
Format: (000) 000-0000.
What is the name of the business?
Does the business have a website?
*
Yes
No
Business Website URL
What type of sales transactions does your business partake in?
Business-to-Business (B2B)
Business-to-Consumer (B2C)
Business-to-Government (B2G)
Unsure
Is the business set up as a legal entity?
*
Yes
No
Select the type of legal entity.
Limited Liability Company (LLC)
Partnership
S or C Corporation
Sole Proprietorship
Other
What general type of business is this?
What is your company mission & values?
Number of Full-Time Employees
0
1-3
4-15
16-50
50+
Number of Part-Time or Contract Employees
0
1-3
4-15
16-50
50+
How many years has the business been in operation?
What are your Gross Revenues?
Below $500,000
$501,000- $5,000,000
$5,000, 001 - $10,000,000
+$10,000,001
Do you have solid financial support?
Yes
No
I'm not sure
What is the biggest challenge you are facing right now?
Cash Flow Management
Financial Planning and Analysis
HR Management
Cost Control
Access to Capital
Strategic Planning
Revenue Growth
I'm not sure
I record, organize, and classify financial transactions (bookkeeping):
Monthly
Quarterly
Annually
I haven't done any bookkeeping for my business yet
I'm not sure
I review profit and loss statements for my business:
5 or more times per year
3-4 times per year
Once per year
I'm not familiar with profit and loss statements
How I budget for my business:
I create a detailed annual budget and strictly stick to it.
I create business budgets but don't adhere to them.
I have a high-level budget that I refer to occassionally.
I don't make or track budgets.
I have a formal business plan:
Yes, it's working great.
I created a formal business plan at one point but do not refer to it.
I have a plan in my head (and that's enough for me).
No plans, I like to go with the flow.
Yes, but it's not working well.
No plan, but I need one.
I regularly forecast and monitor cash flow:
Weekly
Monthly
A few times a year
I don't forecast cash flow.
I have a plan for unexpected expenses:
Yes, I am mostly prepared for anything.
I'm prepared for minor expenses (but nothing major).
I don't have a plan, but I'm good at finding solutions.
No, unexpected expenses will put my business in jeopardy.
Let's talk about financial performance.
Together, we can take a closer look at your business' performance to date.
I feel prepared to cover operating expenses using cash-on-hand for:
More than a year
7-12 Months
4-6 Months
1-3 Months
Less than month
I don't know this
During 2022, my business' total revenue was:
During 2023, my business' total revenue was:
My business' net income margin for 2023 was:
More than 20%
16-20%
11-15%
6-10%
0-5%
Less than zero
I don't know this
My current monthly operating profit is:
My current monthly debt payments are:
What does your company do better than others?
What is the long term vision for your products or services?
e.g. Repositioning the product, expanding to another market.
What are your top 3 customer pain points?
List your the top 3 competitors
Describe the management experience of the leadership team:
List the areas/departments of the business?
List in detail.
What management and/or business resources outside the company are available?
What financial management accounting system is used?
What Customer Relationship Management (CRM) system do you use?
What Point of Service (POS) system do you use?
What can you improve given your current situation?
What do you perceive as your weaknesses?
Submit
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