Business Background Questionaire Client Details:Business Name:(Required) Office PhoneClient Name: Mobile PhoneEmail Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date MM slash DD slash YYYY Your Business:What type of business are you in? Professional Service Manufacturing Retail Wholesaler/Distributor Other Other: Please list the specific types of products and/or services you provide for your customers.How long have you been in business? How did you acquire this business? Started Bought existing Franchised Inherited Other Other: Who, other than yourself, is involved in the decision making of your business?Please describe your main challenges. What holds you back? Be specific.How many hours per week do you currently work on average? How do you feel about this?Your Marketing:Why would a customer buy from you and not your competition? What makes you unique?How do you generate leads for your business? Please provide estimated percentages on the following:RadioDirect MailMagazine AdvertisingDaily NewspaperCataloguesWalk-InsLocal PaperFace to face callingOtherTelevisionReferralsTelemarketingFlyersWhat is your conversion rate (i.e., what % of leads actually buy from you)? Is your conversion rate estimated or measured? Estimated Measured Your Sales Goals:What revenues and profits has your business generated in the past 3 years and what do you project for the current year? If you do not have 3 years history, just include the years you do have. Note: This is completely confidential and will not be shared to anyone.What percentage growth do you expect to see in the next 12 months? How do you see this growth being achieved? Yourself as a Business Owner:What percent of your time, on average do you devote to the following activities:Strategic PlanningBusiness Development and MarketingDay-to-day Operational and Tactical RequirementsTrouble-shooting and FightingFiresOtherPlease describe your strengths as a business owner:Please describe the areas where you need improvement as a business owner:On a scale of 1 to 10, please rate your skills (S) and interests (I) in the following key areas with 1 being the least possible and 10 being the highest.Skills:Leadership (S)Please enter a number from 1 to 10.Marketing (S)Please enter a number from 1 to 10.Sales (S)Please enter a number from 1 to 10.Finance (S)Please enter a number from 1 to 10.Operations (S)Please enter a number from 1 to 10.Strategic Planning (S)Please enter a number from 1 to 10.Goal Setting (S)Please enter a number from 1 to 10.Customer Service (S)Please enter a number from 1 to 10.Decision Making (S)Please enter a number from 1 to 10.Employee Development (S)Please enter a number from 1 to 10.InterestsLeadership (I)Please enter a number from 1 to 10.Marketing (I)Please enter a number from 1 to 10.Sales (I)Please enter a number from 1 to 10.Finance (I)Please enter a number from 1 to 10.Operations (I)Please enter a number from 1 to 10.Strategic Planning (I)Please enter a number from 1 to 10.Goal Setting (I)Please enter a number from 1 to 10.Customer Service (I)Please enter a number from 1 to 10.Decision Making (I)Please enter a number from 1 to 10.Employee Development (I)Please enter a number from 1 to 10.What are the biggest frustrations you have with your own business?What are your hobbies? How do you currently spend time outside of your business?If you had enough time and financial resources to do anything you choose, how would you spend your time outside of your business?Which statement best describes you? Tick/CheckOne… I’m an action oriented person who is most comfortable when in charge. I’m a ‘people’ person who values friendships in my work relationships and likes to build consensus. I’m calm and cool under pressure and like to make logical rather than emotional decisions. I like to study lots of information before making decisions. Your Team:Currently1 Year ago2 Years agoIf there was one thing you could change about your business in the next 90 days, what would it be and why?Is there any additional information you feel would be valuable for our discussion?Thank you for taking the time to complete this questionnaire. It’s very important for both of us to fully understand your current situation—that way we can focus on the areas of greatest need and importance to you. If you have any specific questions on any area of the questionnaire, please don’t hesitate to contact me at:shannonfiling@actioncoach.com or 402-587-6329
