Eligibility Form

Client Info

Full Name *

Website

Business Name *

D/B/A (If Applicable)

Business Number

Mobile Number *

Business Email *

Personal Email

Mailing Address

Industry Classification

Other Industry

Please briefly describe your business or organization in 2 to 3 sentences

Your role within the organization

Other Role

Consulting Info

What kind of assistance do you need?

Start-up Planning, Feasibility, etc. Business Planning Accounting / Financial Analysis Business Expansion Market Strategy and Research Operations Management Solving a Problem or Challenge Promotion / Marketing / Advertising Staff Management

Other Assistance Needed

What is the biggest challenge you are facing right now?

Other Challenge

How long have you been in operation?

Do you have any employees?

Other Employee Count

# of Full-time

# of Part-time

What are your short-term financial goals? (e.g., break-even, become profitable, achieve sales targets, etc.):

Briefly describe your typical customer — or the customer you would like to attract

Why do you think you need a consultant, and what results are you looking for?

Are there any specific deadlines or timeline we should be aware of?

Additional Info

Method for revenue received

Cash Zelle Cash App

Other Revenue Method

Target Monthly Goal

How often do you track your expenses?

Itemized Expenses / Notes

Do you have a business bank account?

Are you registered and active on sunbiz.org?

Have you applied for an FEIN with the IRS? (Federal Employee Identification Number)

Methods for marketing / advertising

Facebook Instagram Twitter

Other Marketing Method

Business Hashtags (If Applicable)

How often do you post content?

Does the business have a logo?

Does the business have a tagline?

If yes, please list the tagline

Do you have any brand merchandising?

If yes, please list

Any promotional giveaways for customers?

If yes, please list

How did you learn about us?

Other Source

Is there anything else you think we should know?

Acknowledgment

Full Name *

Date *

I confirm that I have read and understand this document.

Intake Questions for Small Business Owners & Entrepreneurs

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Client Intake Form