Name *
Company *
Title/Position *
Address *
Phone *
Email *
Website *
What is the highest level of education completed?
Are you on Linked In? *	Yes No
Are you on Face Book? *	Yes No
How many connections do you have?
Do you have a Blog? *	Yes No
What Business Organizations are you a member of? *
What Social Organizations are you a member of? *
How many networking events do you attend each month? *
What was the last book you read? *
How many hours per week do you work?
How long have you been with your company? *
How long have you been in line of business? *
How many people work for your company? *
What is your primary product or service? *
What other products or services do you offer? *
How many appointments do you have weekly with clients? *
How many appointments do you have weekly with prospects? *
How do you regularly keep in touch with your clients and prospects? *
Do you have partnerships/alliances with complementary companies? Please list by industry. *
Do you work with a team or by yourself?
Do you cold call? *	Yes No
Are you limited to a territory? What is it? *
What geographic region do you target? *
How many new clients are you looking to add each month? *
how do you currently find your clients? *
What percentage of your clients come from referrals? *
Are your primary clients businesses or individuals? *
Who is the decision maker of your clients? *
What is the average income/revenue of your average client? *
Do you target a specific industry or type of person?