Business Assessment Form
Participant Name
*
First Name
Last Name
Suffix
Participant Role
*
e.g. Chief Executive Officer (CEO), Partner, Vice President, Founder, etc.
Participant Email
*
example@example.com
Participant Phone Number
*
Format: (000) 000-0000.
What is the name of the business?
*
Does the business have a website?
*
Yes
No
Business Website URL
Does your business have a physical address?
*
Yes
No
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the business set up as a legal entity?
*
Yes
No
Select the type of legal entity.
Limited Liability Company (LLC)
Partnership
S or C Corporation
Sole Proprietorship
Other
What general type of business is this?
What is your company mission?
What is your company's vision?
What are your company values?
Number of Full-Time Employees
0
1-3
4-15
16-50
50+
Number of Part-Time Employees
0
1-3
4-15
16-50
50+
Number of Contract Employees
0
1-3
4-15
16-50
50+
How many years has the business been in operation?
What are your Gross Revenues?
Below $100,000
$101,000 - $500,000
$501,000- $1,000,000
$1,000, 001 - $5,000,000
+$5,000,001
Do you have solid financial support?
Yes
No
I'm not sure
Would you like additional information on our funding resources for small businesses?
Yes
No
Please list any key individuals in the business
What are the businesses products and/or services?
What are your existing sales tactics?
Direct, E-commerce, etc.
What type of sales transactions does your business partake in?
Business-to-Business (B2B)
Business-to-Consumer (B2C)
Business-to-Government (B2G)
Unsure
Who are your target customers?
Please be specific. e.g. Large manufacturing businesses located in Atlanta, GA.
List your the top 3 customers
Are the purchasers of your product/services who you want them to be?
Yes
No
Unsure
Do you have a unique selling proposition (USP)?
Yes
No
Unsure
What is your USP?
If answered 'No' to the previous question, please provide additional details.
Why do your customers find your products unique and desirable?
What does your company do better than others?
What is the long term vision for your products or services?
e.g. Repositioning the product, expanding to another market.
What is your customer demographic profile?
What are your top 3 customer pain points?
List your the top 3 competitors
How are competitors marketing their products or services?
What are your competitors doing that may impact you?
Are there segments of users who are under-served by competition? Please describe these users in detail and how they are underserved.
Describe the management experience of the leadership team?
List the areas/departments of the business?
List in detail.
Who is responsible for each area/department?
List in detail.
What management and/or business resources outside the company are available?
What financial management accounting system is used?
What Customer Relationship Management (CRM) system do you use?
What Point of Service (POS) system do you use?
What unique capabilities and resources do you possess?
What can you improve given your current situation?
What do you perceive as your weaknesses?
What trends or conditions may negatively impact you?
Submit
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