Atlas Business Questionnaire
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Step
1
of 4
Your Name
*
First
Last
Business Legal Name
Business Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
*
Phone
Industry
*
Aerospace and Defence
Automotive
Construction
Energy and Utilities
Environmental
Fabrication
Government and Public Contracts
Healthcare and Medical
Hospitality Supply
Information Technology
Insurance
Janitorial Services and Supply
Landscape Services
Manufacturing
Media and Entertainment
Mining and Raw Materials
Petroleum and Chemicals
Pharmaceutical & Life Sciences
Security Services
Service Provider
Small Business
Staffing
Telecommunications
Textiles
Uniform Services
Wholesale Distributors
Other
Federal Tax ID
*
Any Tax Liens?
*
Yes
No
State of Business Registration
*
Other States with Business Locations
Incorporation Type
*
Proprietorhip
Partnership
Corporation
Limited Liability Company
Number of Employees
*
1-5
5-10
10-25
25-50
50-100
100+
Year Business was Registered
*
Next
Number of Business Owners
Selected Value:
1
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?
*
Yes
No
Please describe nature of time issues
Have you ever used Invoice Financing or Factoring before?
*
Yes
No
Please Describe Experience, Include name of financing company
*
Are you currently using Invoice Financing for your Business?
*
Yes
No
Name of Financing Company
*
When does your contract expire?
*
Next
Has your business ever taken a loan?
*
Yes
No
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
Net 15
Net 30
Ned 45
Net 60
Net 90
Net 120
120 +
How many customers do you currently have?
Selected Value:
1
Next
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
Equipment Financing
Other Lending
Establish (Business) Credit
Loan Consolidation
Business Consulting
Business or Management Coaching
Sales or Management Consulting
Business Analysis
Efficiency Improvement
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.
*
Acknowledged
Thank you
Your Business Advisor will be in touch with you shortly.
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