Name:___________________________ Home Telephone: __________ Alternate Phone ___________

Address:______________________ City: ____________________State :______ Zip: _____________

Email Address: ____________________________ Resume:______________________

What Business are you in now? _____________________________ Education Level: _____________

If we find businesses that meet your needs, are you ready to talk to that company? _______________

When you find the right Business how soon do you want to get started? _______________________

Have you ever owned a business? ____ What kind? _________ Why not in it Now?______________

How Long Have you been Looking?___________________ Married/Kids?________________________

What business is he/she in? _________________________ Any other Partners?_________________

What other businesses have you looked at?_______________________________________________

Did you like any of them?__________ Why or Why Not?_____________________________

Rank your favorite business functions: Sales ______ Customer Service ______ Administration ______

Strengths/Weaknesses? _______________________________________________________________

Mgmt. Experience/Interest? ____________________________________________________________

Why do you want your own business? ____________________________________________________

What are the most important elements of your new business? (Entry Cost, Ease of Operation, Potential

to Build Equity, Time Commitment, Proximity to Home, Prestige, Family Friendly Hours, Product or

Service, Net Profit) ___________________________________________________________________

What environments appeal to you? RETAIL / MOBILE SERVICE / OFFICE SETTING / LIGHT

INDUSTRIAL

Preferred Business Type __________________ Anything you don’t want? ______________________

What income are you replacing? ____________ Income goals for the business? _________________

Estimated Net worth? ________________ Ideal investment range? ____________________________

Liquidity? _______________________ Do you want full or part time? _________________________

Location Preference ___________________________________________________________________

Any additional information that would help us locate a business suited to your goals?

__________________________________________________________________________________

Appointment set for: Date __________ Time ____________ Phone/ In person __________________

NOTES:

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