Business Structure & Funding Assessment Form
This intake allows us to assess your current business structure, compliance posture, and scalability readiness.
01. Client Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
State of Residence
02. Business Status Overview
Business Name (if applicable or "N/A")
*
Website or Domain (if applicable)
Social Media (if applicable)
Is your Business Currently Registered?
*
Yes
No - Startup Phase, need your Assistance with Formation+
Other
State of Business Registration (if different or "N/A")
Current Entity Type?
*
None - Need Assistance with Formation+
Sole Proprietor
LLC (Single Member)
LLC (Multi-Member)
Corporation
Year Established?
*
N/A - Need Assistance with Formation+
Other
Is your Entity Active and in Good Standing? (Or "N/A")
*
Industry / Primary Service of Business?
*
03. Business Structure & Compliance Assessment
This section evaluates your business structure, financial separation, and compliance readiness to ensure scalability, funding eligibility, and long-term protection.
Select All Currently Established (or "N/A")
*
Revocable Trust
RA (Registered Agent)
Business Name (Or need Assistance Choose "Other")
Business Toll-Free Number (1-800 number)
Business Email (Info@yourbusinessname.com)
Business Address (Brick and Mortar, or VA Virtual "Corporate" Address)
Website or Landing Page
Online Business Creditability (411 Listing, Google my Business, Yelp, Apple/Bing Maps)
Business EIN Established
NAICS Code (Business Industry)
Business Operating Agreement
Certificate of Good Standing
Certificate of Authority ("Foreign Entities")
Bookkeeping System in Place
Operating Business Checking Account
Dedicated Tax Savings Account
Payroll/Owner Pay Account
Operating Revenue (3-6 months saved)
Profit Allocation Account
Business Insurance Policy
DUN & Brad Street Account + Number
Business Credit Profile Established/Paid Tradelines
Whole Life Policy
None - Need Full Setup Guidance
Other
Months of Operating Expenses Currently Reserved:
*
0-1
1-3
3-6
6+
Other
04. Capital & Credit Profile Review
Personal Credit Profile + Business Credit Profile
Estimated Credit Score Range:
Below 580
580-650
650-700
700+
Unsure
Other
Any Active Derogatory (Negative) Accounts?
Yes
No
Unsure
Current Revolving Utilization (if known):
Below 30%
30-60%
Above 60%
Unsure
Is your Business Reporting to Commercial Credit Bureaus? (or "N/A")
Yes
No
Unsure
Other
Current Trade Lines Established:
Net 30 Accounts
Business Credit Cards
Business Line of Credit
Equipment Financing
None
Other
Previous Funding Applications:
*
Approved
Denied
Not Yet Applied
05. Strategic Objectives & Goals
Primary Objective:
*
Business Formation & Alignment (Paid Strategy Call Session)
Compliance Entity Audit of your Business (Paid Strategy Call Session)
Assistance with Updating Business Systems & Online Operations
Credit Profile Review & Optimization
Funding Preparation & Readiness
Capital Access Strategy
Asset Protection Planning
Digital Setup (Email, Workflows, Tools)
Long-Term Wealth "Assets" Structuring
Other
Do you Plan to Acquire Income-Producing Assets within the Next 12 Months?
Yes
No
Exploring Options
Other
Is Ownership Currently Structured under a Trust?
*
Yes
No
Planning to Establish One
Need Assistance with Formation+
Other
06. Timeline & Investment Readiness
When do you plan to have your Business Operational/Request Business Audit?
*
I'm ready now
Within 2 weeks
Within 30 days
60+ days
Other
How Many Hours Per Week can you Realistically Commit to Implementing Guidance?
1-2 hours
3-5 hours
5+
Other
How do you typically respond to Structure and Accountability?
I follow through Consistently
I need reminders but Take Action
I struggle to stay Consistent
Other
Describe your Long-Term Financial Goals (3-5 Years):
07. Final
How did you hear about us?
Instagram
Facebook
TikTok
Referral
Website
Other
Anything else we should know before reviewing your Submission? (Optional)
By submitting this form, I understand this is not a guarantee of services and that a paid discovery call is required if approved.
Capital and credit strategy guidance is advisory in nature. Funding approvals and financial outcomes depend on lender criteria, compliance standards, and individual financial profiles.
I understand
Submit
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