Atlas Business Questionnaire
Business Legal Name
Address Line 1
Address Line 2
District of Columbia
Aerospace and Defence
Energy and Utilities
Government and Public Contracts
Healthcare and Medical
Janitorial Services and Supply
Media and Entertainment
Mining and Raw Materials
Petroleum and Chemicals
Pharmaceutical & Life Sciences
Federal Tax ID
Any Tax Liens?
State of Business Registration
Other States with Business Locations
Limited Liability Company
Number of Employees
Year Business was Registered
Number of Business Owners
Please list all owner names and percentage of ownership
Describe the Business, and Growth Projections (next 12 months)
Are there any time frame issues we should be aware of?
Please describe nature of time issues
Have you ever used Invoice Financing or Factoring before?
Please Describe Experience, Include name of financing company
Are you currently using Invoice Financing for your Business?
Name of Financing Company
When does your contract expire?
Has your business ever taken a loan?
Please Provide loan information and details
Current Balance owed to pay off loans
What is the Business' Average Monthly Revenue?
What are your terms? (check all that apply)
I don't offer terms to customers
How many customers do you currently have?
Please provide the following information for the Top 5 Customers
- Customer Business Name - Average Invoice Size - Average Invoiced Monthly - Total Sales last 30 days - Total sales last 12 months
Customer 1 Information
Customer 2 Information
Customer 3 Information
Customer 4 Information
Customer 5 Information
Please provide information about money owed to your business
Total Accounts Receivable Right Now
A/R Aging (0-30)
A/R Aging (31-60)
A/R Aging (61-90)
A/R Aging (91-120)
A/R Aging (120 +)
Please Select the Service you Wish to Discuss with your Business Advisor (Select all that apply)
Factoring (Invoice Financing)
Purchase Order Financing
Establish (Business) Credit
Business or Management Coaching
Sales or Management Consulting
By submitting this questionnaire form to Atlas, I understand and am aware that the information I have provided may be used to qualify and search for partners within the Atlas Business Consulting network of partners in order to match their offers and services with the needs of my business. I further attest that everything provided in the attached questionnaire form is true and accurate to the best of my knowledge at the time of submission. I hereby grant my permission as an officer of my company to Atlas Business Consulting to act on my behalf in an effort to fulfill the requests I have made of them, and share any information with the members of their partnership network as may be required for that purpose and share the results with me so that I can make the best decisions for my company. I understand that all information contained in this questionnaire is considered confidential and only limitedly shared within the confines of the network group. Under no circumstances does the submittal of this questionnaire serve as a binding contract or obligate either me or my company in any way to do business with Atlas Business Consulting, its partners, or assigns.
Your Business Advisor will be in touch with you shortly.