Please provide the following contact information: (Items with * are required.)

I am interested in the following type of small business...

The reason I want to be in business is...

I have previous business experience in ...

The most difficult problem I face in doing business is...

If I were to die tonight I would go to heaven because...

Other Comments or Questions

Please answer the following questions:

1. Is the primary reason why you want to have a business because you want to make money?

   Yes
   No

2. Do you know what type of business you want to start?

   Yes
   No

3. Have you ever worked in a similar type of business?

   Yes
   No

4. Have you ever been in a position in which you were responsible for other people?

   Yes
   No

5. Have you ever started something new?

   Yes
   No

6. Have you ever taken a course in business training?

   Yes
   No

7. Do you have the support of your family for your plans to start a business?

   Yes
   No

8. Do you know people who could help you to start your business?

   Yes
   No

9. Do you have relatives who have operated their own small business?

   Yes
   No

10. Do you feel comfortable taking a risk?

    Yes
    No

11. Do you have some money saved to start a business?

    Yes
    No

12. Do you know about how much money you need to start it?

    Yes
    No

13. Do you have friends or family who will help you with the money you need to start a business?

    Yes
    No

14. Have you done any research about the business you are planning to start?

    Yes
    No

15. Do you know who your customers will be?

    Yes
    No

16. Have you talked to your potential customers about your plans to start a business?

    Yes
    No

17. Do you know about how much money you will need from your business to provide for yourself and your family?

    Yes
    No

18. Do you know who are your potential competitors in the marketplace where you will conduct business?

    Yes
    No

19. Do you know the potential location of your business?

    Yes
    No

20. Do you know what legal obligations you will need to meet in the start up of your business?

    Yes
    No

21. Do you use a budget to manage your personal finances?

    Yes
    No

22. Have you ever borrowed money that you did not pay back?

    Yes
    No

23. Do you have a written business plan for the start up or expansion of your business?

    Yes
    No

24. Have you shared your business plan with other people for their input and counsel?

    Yes
    No

25. Do you know a potential business partner?

    Yes
    No
    
    Thank you.  the Scruples Small Business Coach will respond to your submission shortly.
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