Business Review Form

Business Review Form

Complete this online business review to share your business, protection needs, employee benefits, risks, and future goals.
Business Information
Business Name
Owner Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Business Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Website
Industry
Years in Business
Number of Employees
Annual Revenue Range
Business Continuity and Ownership
If something happened to you tomorrow, what would happen to the business?
Do you have business partners?
If yes, what percentage ownership do they have?
Do you currently have a buy-sell agreement?
Do you have any life insurance specifically intended to protect your business?
Coverage Amount
Purpose

Other
Personal Protection and Household
Marital Status
Number of Dependents
Approximate Household Income
Currently Have Disability Insurance
Do you currently have personal life insurance coverage?
Carrier(s):
Approximate Total Coverage Amount:
Type of Coverage (check all that apply):
Primary Purpose of Coverage (check all that apply):

Other
When was your coverage last reviewed?
How confident are you that your current coverage would adequately protect your family if something happened to you?
Currently Have Long-Term Care Coverage
Currently Have Health Insurance
Currently Have Retirement Savings Strategy
How many years until retirement?
Biggest Concern

Other
Employee Benefits and Workforce
Do you currently offer health insurance?
How many full-time employees?
How many part-time employees?
Benefits currently offered

Other
Biggest employee benefits challenge

Other
Interested in learning about

Other
Business Risk, Debt & Future Goals
If you became disabled and couldn't work for 12 months, what would happen to the business?
Do you have a Business Loan?
Do you have an SBA Loan?
Do you have Equipment Financing?
Do you have a Commercial Lease?
Do you have Lines of Credit?
Approximate Business Debt
Do key employees contribute significantly to revenue?
Do you have key person insurance?
Goals Over the Next 3-5 Years

Other
Other Future Goals
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Should be Empty:

Business Review Form

Business Information

Business Continuity and Ownership

Personal Protection and Household

Employee Benefits and Workforce

Business Risk, Debt & Future Goals