Confidential Questionaire

  • Personal Data

  • Enter 0 if none.
  • High school, college, graduate degree
  • High school, college, graduate degree
  • Please list your hobbies, special interests, etc.
  • Employment

  • Business Ownership Data

  • Check all that apply
  • Using a scale of 1 to 10 (with 10 being the highest level of interest, and 1 being the lowest), please rate your personal interest in the following areas:

  • Describe how much you would enjoy the following roles

  • Check top choice
  • Check top choice
  • Check all that apply
  • If not listed above, please describe
  • Lifestyle Data

  • Please list city/state
    1.2.3. 
  • Please check top choice
  • Please check top choice
  • Financial Data

  • Assets

  • market value
  • market value
  • market value
  • Liabilities

  • Total Assets minus total liabilities.
  • The following information is requested because any affirmative answers may have a direct bearing on your ability to obtain financing for starting a business. This is a critical factor in determining which companies may match with your criteria.

  • All of the information stated herein is a true and correct representation of my personal and financial condition. It is understood that the purpose of this questionnaire is to compile general information and that it is in no way binding upon either party. This is not a contract.

  • This field is for validation purposes and should be left unchanged.

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