Client Worksheet

Please complete our worksheet to help us to better understand and evaluate your background and current situation.


First Name
Last Name
Address (street)
Postal Code
Best Time to Call
If college, what type of degree?
Are you a veteran?
What is your level of education?
Are you currently employed?
If your answer is yes, is it Full-Time or Part-Time Employment?
If you're currently employed, please tell us the type of company.
If you have a spouse or significant other what is their name?
How involved will they be in your new business?
What are your primary reasons for a possible career change, exploration of business ownership, or investment in a business?
Businesses can operate out of various places. With business ownership, you have control over where you would like to go to work every day. Please tell us your preference from one of the following:  Work From Anywhere, Home Office, Office Space/Building, Retail Location.
Approximate time-line - If you were to decide to own your own business, approximately how soon would you like to begin the operations of this potential new business?
Have you owned any businesses or been self-employed? If yes, please describe.

Have you researched any business ownership options in the past? If yes, please describe.

Available Resources:It's important that we have an understanding of your resources so that we can provide the most relevant advice, coaching and assistance. You can be assured that any financial information you share is always confidential. What would you estimate your total net worth to be (total assets minus total liabilities)? For example: Equity in your home, stocks and bonds, cash on hand, savings, 401K and or retirement fund. Please enter your estimate below.
In 5 years I will have more:
In 5 years I will have less:
In 5 years I will no longer need to tolerate:
Describe your INCOME in 5 years:
Describe your LIFESTYLE in 5 years: