DBB New Client Intake Form

1
Client's Name* This field is required.
First Name
Last Name
2
Client's Number* This field is required.
3
Client's Emaill* This field is required.
example@example.com
4
Client Demographics* This field is required.Please use address that you registered with your state if you’re a business.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Let’s Start Building …What Is Your Availability Start Date * This field is required.Must be within 14 days of this form. Submission will be invalid.
Date
Month
Day
Year
6
Do You Live or Is Your Business Based In Florida?
YESNO
7
Business Industry * This field is required.If Not A Business, put N/A
8
Legal Company Name* This field is required.If Your NOT A Business or Your Business Isn’t Registered, Enter N/A.
9
Our Services* This field is required.Additional Professional Services
Business Management/Training Staff
Marketing & Advertising
Business Credit & Bank Funding
Business Funding (Government)
Legal Documentation & Tax Legalities
I need 2 or more services above
*Basic Business Startup ONLY To Get Certified To Do Business with the State of Florida
Estate Planning & Asset Protection
Personal Credit Restoration & Money Management
Nonprofit Funding & Community Partnership
Personal Credit Restoration
10
Please select an appointment below for the initial assessment or consultation* This field is required.Do Not Schedule Same Day Consultation Unless Instructed To.
11
What is your Business/Personal Credit Score?If you don’t know it, please put N/A
12
Could your business benefit from business loans, credit or state assistances/grants?
Yes, My Business Need Funding
No, Our Company Is Flooded With Funds
I Don’t Have A Business
13
Does your business have a clear vision and mission statement?
Yes
No
I’m Not A Business
14
Do you know who’s your Target Audience? What is your ideal client? Please describe them briefly.If you’re not a business, please tell me what is your financial situation & goal.
15
What are your current motivations in doing or starting this new business?If you’re not a business, please tell me what is your short term goal, within the next 6-12 months.
16
Share the biggest success of your business or highlight the time that made you feel like this Entrepreneurship Journey could be for you.If you’re not a business, please tell me what was it that made you decide to take the next step Today towards financial freedom.
17
Please share the challenges and obstacle your business/personal life is currently facing* This field is required.If you’re not a business, please be as detailed as possible, what hurdles are you facing that feels too big for you to conquer on your own.
18
After 2 years, how do you see your business & profit projection?Put N/A if Doesn’t Apply
19
What are your products and/or services?* This field is required.Put N/A if Doesn’t Apply
20
How do you differ from your competitors?If you’re not a business, please put N/A.
21
How do you gain clients? How do you generate leads?If you’re not a business, please put N/A.
22
What is your marketing and advertising strategies?If you’re not a business, please put N/A
23
What are the software or web applications you're using to manage your data, sales, and marketing? Please list them all below.If you’re not a business, please put N/A.
24
How do you support your customers?If you’re not a business, please tell me in what ways do you give back to your community or how do you spend your extra money monthly.
25
I, First Name Last Name understand that the submission of this application doesn't guarantee a service contract with Drina the Biz Builder Business & Financial Service Firm. I understand & agree to submit this application honestly and make my first consultation full payment immediately or within 24 hours of submission of this application. Upon acceptance as a client, following your first paid consultation, the non-refundable service premium charge is due in Full or Installments if approved for Financing.
26
Date Signed
Date
Month
Day
Year
27
How likely are you to refer our company to your business partners & clients. With 5 star being highly recommended.
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2
3
4
5
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