Name:

Company:

Address:

City:

State:

Zip:

Phone:

E-mail:

1. As a business owner, what are the three biggest challenges of running your business? (mark all those that apply)

California economy

Availability of skilled labor/employee turn-over

National economy

Availability of credit

State and/or local business regulations

Commercial real estate/rent cost

Increased taxes

Competition

Healthcare costs

Liability issues

Workers Compensation Insurance Costs

2. Do you have a current business plan that addresses some or all aspects of your business?

 Yes       No

3. Did you reach your annual sales and revenue goals last year?

 Yes       No

4. Are you on track to reach your annual sales and revenue goals this year?

 Yes       No

5. Do you consider your current marketing efforts to be both effective and cost-effective?

 Yes       No

6. What part of your business’ administration do you feel is the source of most challenges to your business?

7. Do you have a Payroll/Tax/Human Resources Expert available to you?

 Yes       No

8. Are you maximizing all your tax strategies and capitalizing on our profits?

 Yes       No

9. Do you plan to make any significant changes to the ownership or management structure of your business? If yes, are you planning to:

 Yes       No

Sell

Acquire

Merge

Transfer all or part of ownership

Take on a Partner

Bring in new managers or executive level employees

10. Are you planning any business expansion? If yes, are you planning to:

 Yes       No

Purchase a building

Equipment purchase/lease

Purchase a larger facility

Hire more than ten (10) additional employees

Tenant/Leasehold/Property Improvements

Add new line(s) of business

Refinance

11. How did you hear about BRC?

Thank you for filling out this information. A BRC representative will set an appointment with you in the next few business days to present the results of your Business Health Assessment. For a more detail assessment, please open the following PDF document (Business Health Assessment) and fax it to 951.689.8003