Start Up Business Assessment Survey

Start-up Business Assessment

First Name *

Last Name *

Company Name *

Work Phone *

E-Mail *

Address 1 *

City *

State/Province *

Postal Code *

Although the fields below are not required, the more information you provide, the better able we will be to assist you. Please answer all questions to the best of your knowledge. Please note that all information you provide will be considered proprietary and confidential.

Why do you want to start a business?

How much funding will your business require to start (estimate)?

Describe your business idea and the types of products and/or services you will offer:

Do you have any collateral (real estate, inventory, equipment, vehicle, CDs, stock)? If Yes, please identify the type of collateral in the extra text field provided.

Yes

When do you plan to start the business (month, year)?

Please estimate your first-year sales?

How do you plan to finance the start-up of your business?

If you require financing, what will the money be used for?

How much money do you have available to invest in the business?

What is your current occupation?

Marital Status

Do you have a current copy of your credit report? (if “Yes,” please bring it to your initial meeting)

What is your current credit score?

What is your current annual household income?

Which legal structure are you considering for the business (choose only one)?

Have you registered the name of your business?

Do you currently have a draft of your business plan?

Have you filed for bankruptcy within the past ten years?

Do you have a CPA or accountant?

Do you have a lawyer?

Have you ever started or owned a business before?

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