Customer Service Forms

Tell Us More About You
To help us with your coaching experience, please complete the information requested below. This should only take about 10-15 minutes to complete.
NAME*
ADDRESS*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
AGE
E-MAIL ADDRESS*
CELL PHONE
Area CodePhone Number
HOME PHONE
Area CodePhone Number
BEST NUMBER TO REACH YOU
REASONS FOR POSSIBLE CHANGE
What are your primary reasons for a possible career change, possible exploration of business ownership, or possible investment in a business?
Please select all reasons for possible change that apply.
Tired of Corporate WorldImproved LifestyleIncreased EarningsMore SatisfactionInvolve Spouse or FamilyReinvent CareerIndependenceControl of CareerWealth-BuildingAdditional Income StreamLifelong DreamBuild an EmpireOther
WHERE
Businesses can operate out of various places. With business ownership, you have control over where you would like to work every day.
Geographic Area:
Where would you like your business to be located? (City/State)
Daily Location: Please select your daily location preferences
Home OfficeOutside OfficeMobile Service BusinessLight Industrial AreaRetail Plaza or Mall
How important is this daily location to your happiness?
Time Commitment
Full Time - New CareerPart Time - Limited hours and/or keep existing job
Approximate timeline: If you were to decide to own your own business, and could find the right opportunity, approximately how soon would you like to begin the operations of this potential new business?
BUSINESS OWNERSHIP AS AN OPTION
Have you previously owned a business or been self-employed? If yes, please describe.
Have you researched any business ownership options in the past? If yes, please describe.
BUSINESS SKILLS ASSESSMENT

Please rate your general skills/abilities in the areas listed below.

	Not Skilled	Minimal Skill Level	Average Skill Level	Good Skill Level	Very Skilled
General Management/Operations
Marketing Strategy
Sales
Networking and Relationship Building
Coaching, Consulting, Teaching, Presenting
How handy are you? (building, fixing, etc.)
Bookkeeping, Administrative

GROWING & SCALING YOUR BUSINESS
Understanding that over 50% of people who own a franchise own more than a single unit, and factoring in your financial goals, would you be interested in learning more about:
Multiple Units (e.g. The rights to own and manage more than one unit and/or territory within a specified geographic area.)Area Development (e.g. The rights to own, develop and manage a large number of units or territories within a specified geographic area.)Master, Executive, or Regional Development (e.g. Functions and earns revenue very much like the franchisor, within a specified territory. Typically recruits new franchisees and creates revenue by sharing in franchise fees and royalties. Possibly owns and operates a unit of their own.)
INCOME, LIFESTYLE, WEALTH & EQUITY
The goal of business ownership is to use it as a vehicle to get to the future you want to desire. At The Entrepreneur's Source we focus on the your ILWE goals, or Income, Lifestyle, Wealth & Equity goals.
Income goals are what you will need annually to support yourself and your family.
Lifestyle goals are how you live your life, for example, do you want to purchase a boat or a fancy car, maybe you expect to have college tuition payments, or a child's wedding to plan for. Do you plan to stay in your existing home or are you looking to upgrade your home, or possible downsize your home?
Wealth goals are what you will build up in the bank and other assets that you may purchase over your life time.
Equity goals relate to the value of your business when you decide to sell it, or exit the business.
What level of annual income are you looking to replace?
Where do you see yourself in three to five years? Five to 10 years?
If we looked at your life a year from today, what has to have happened during that period, both personally and professionally, for you to be happy with your progress?
POSSIBLE BUSINESS AREAS OF INTEREST
Franchising typically requires no industry experience, you receive intensive training, and you get surrounded by industry experts who are committed to your success. This creates numerous possibilities for our clients. Please select some of your possible Business Areas of Interest below. Some advice: Be creative, and have fun with this category! Our goal is to help our clients to reinvent themselves, and often that means working in a whole new industry. Franchisors are looking for people who can manage & market a proven business model. Be prepared to discuss why you chose to check off various options.
Please select all categories of interest.
AdvertisingAutomotive Sales/Services/Products/RentalBuilding/Construction/Remodeling/Home ImprovementChildren's Products or ServicesCleaning - Residential/Commercial/Restoration (Water damage/fires/floods)Computer & Internet ServicesCoaching/ConsultingDecorating/Design/Home FurnishingDirect Mail/Web AdvertisingDistributorshipEducation & TrainingElder Care & Other Senior ServicesEmployment/Staffing/RecruitingEnergy & EnvironmentalFinancial/Investment/Insurance & Business ServicesFood: Casual Dining/Bars/PubsFood: Ice Cream/Frozen Yogurt/SmoothiesFood: Coffee and/or BakeryFood: Catering & DeliveringFood: Fast FoodHospitality Products & ServicesHair Care/Personal Care/Beauty/JewelryHealth/Fitness/Gyms/Sports/RecreationHome InspectionMailing/Packaging/ShippingMassage/Tanning/SpasPest Control ServicesPet Products & ServicesPhotography & Photo ServicesPrinting Imaging MarketingReal Estate - Sales or LeasingRetail: ClothingRetail: Consumer Electronics Products & ServicesRetail: Niche or SpecialtyRetail: GeneralSecuritySign ManufacturingStorage ServicesTravel & CruisesVendingOther
EDUCATION
If education were available to help you research business ownership more effectively, and launch a business more successfully, would that be of interest to you?
YesNo
CRITERIA & CONCERNS
What concerns, if any, do you have about investing in a possible business?
What are your most important criteria about any opportunity that you would research?
WHO ELSE?
If you have a spouse or significant other, what is their first name?
Would they have a role (ownership and/or employment) in a possible new business venture?
What are their thoughts about business ownership as as option for you?
If you were to research options, would you wish to include them in any future calls or meetings?
Will you be the only investor, or is it likely that you will have a co-investor?
I plan to be the only investor.It is likely that I will have a co-investor.
Who will be your co-investor? (e.g., Parent, Sibling, etc.)
CONFIDENTIAL FINANCIAL INFORMATION
Available Resources:
As your potential Coach, it’s important that I have an understanding of your resources, so that I can provide the most informed advice, coaching, and assistance. You can be assured that any financial information you share with me is always confidential.
What would you estimate your total net worth to be today (total assets minus total liabilities)?
Please select the best estimate of your net worth using the drop down menu below.
EDUCATION OF FUNDING RESOURCES
At The Entrepreneur's Source (TES), we have several referral partners who specialize in franchise funding. They would be pleased to talk with you, review your personal situation, and educate you about various funding options that would best suit your needs.
Please select one:
I would benefit from some education on various funding options.No thanks, I have the funds that I need, or I have an existing source in place.
Should be Empty:

Tell Us More About You