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Intake Form
COMPANY INFORMATION
Name Of Company
Year Opened
MM slash DD slash YYYY
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
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Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
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Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
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Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
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Eswatini
Ethiopia
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Faroe Islands
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Finland
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French Polynesia
French Southern Territories
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Gambia
Georgia
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Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
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Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
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Malawi
Malaysia
Maldives
Mali
Malta
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Martinique
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Mauritius
Mayotte
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Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
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Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
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Sierra Leone
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Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
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Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Website
Name Of Owners
Owners Email
Owners Phone
How Many Employees
Owners
Sales
Production
Admin/Finance
Total Employees
Is there is an organizational chart yes/no? Please provide a copy if yes.
Yes
No
Is there an operating budget? Please provide a copy if yes.
Yes
No
If you have any regularly scheduled meeting(s) please provide the day, time and attendees.
Are there any Key Performance Indicators (KPI’s) that are tracked and reviewed? If yes, please provide details.
FINANCIAL QUESTIONS
What program do you use for your financials?
Do you manage from Accrual or Cash accounting?
Do you file your taxes on cash or accrual?
What type of entity are you? (Individual, C Corp, S Corp, LLC)
Do you job cost each job in production?
Do you have financial budgets prior to the beginning of a project?
Do you share job costs with your team in a meaningful way during the jobs production?
Do you share job costs with your team in a meaningful way after the job is completed?
Do you have any financial incentive plans in place for your employees. If yes please provide copies.
Do you produce a Work In Progress Report (WIP Report)?
How often do you look at your P&L
How often do you look at your Balance Sheet?
SALES (TOP LINE REVENUE)
Total Annual Revue
How many Total Clients A year (Guess is OK if do not know for sure)
Average Job size
NET PROFIT (BOTTOM LINE)
What was your bottom line net profit last fiscal year? (Negative Numbers OK if you lost money last year) - $
THE INFORMATION BELOW IS OPTIONAL FOR AN INITIAL DISCUSSION. WE WILL EXAMINE THIS INFORMATION CLOSELY TOGETHER IN FUTURE DISCUSSIONS.
DO YOU TRACK YOUR COGS OR GP% ANNUALLY (OR BY JOB)? IF YOU ARE NOT SURE DO THE BEST YOU CAN.
Production labor fully burdened
Production Labor Not Burdened
Sub-Contractors
Liability insurance
Rentals
Trash / Dump fees
Job Materials
Warrantee calls
Production Manager
Vehicle Expenses
Employee benefits
Signage
Permits or fees for projects
OVERHEAD – HOW MUCH DOES IT COST TO RUN YOUR COMPANY FOR A YEAR? IF YOU ARE NOT SURE PLEASE FILL OUT THE BEST YOU CAN.
Liability Insurance
Auto Insurance
Auto Expenses other than owner
Auto Expenses Owner
Admin Labor
Payroll Burdens
Accounting Labor
Owner Pay Burdened
Owner Pay Not Burdened
Admin Employee Benefits
Owner Benefits
Admin Perks
Owner Perks o Medical Insurance other than owner
Medical Insurance Owner
Bank Charges
Interest charges
Finance Charges
Dues and Subscriptions
Life Insurance other than owner
Disability Insurance other than owner
Contributions/Charity
Education/ Training
Marketing
Advertising
Incentives of any sort
Accounting Fees
Office Expenses
Computer/ Tech support
Travel and entertainment
Legal Fees
UPLOADS
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