Free Consultation {"field_77a01c1":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"field_dd411a2","cfef_logic_field_is":"==","cfef_logic_compare_value":"Other","_id":"4f70ad7"}]},"field_2bf396f":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"field_5eac3df","cfef_logic_field_is":"==","cfef_logic_compare_value":"Other","_id":"fb618f2"}]},"field_50647a5":{"display_mode":"show","fire_action":"All","file_types":"png","logic_data":[{"cfef_logic_field_id":"field_b0bbaf0","cfef_logic_field_is":"==","cfef_logic_compare_value":"Yes","_id":"fb618f2"}]}} Business Name Business Owner’s Name Email Address Phone Number: Business Website (if any) Business Location Industry Manufacturing Retail Service Technology Healthcare Hospitality Education Other Specify Years in Operation Less than 1 year 1-3 years 4-7 years 8-10 years Over 10 years Current Annual Revenue Below $50,000 $50,000 - $100,000 $100,001 - $250,000 $250,001 - $500,000 $500,001 - $1,000,000 Over $1,000,000 Number of Employees 1-5 6-10 11-20 21-50 Over 50 Current Financial Challenges Cash Flow Management Access to Funding Budgeting & Financial Planning Debt Management Financial Forecasting Understanding Financial Statements Other Specify Do you currently have a business plan? Yes No Have you ever applied for funding? Yes No What type of funding? What are your top 3 business goals for the next 12 months? What specific outcomes do you hope to achieve through this consultation? What is your biggest obstacle in achieving your business goals? How committed are you to implementing the strategies discussed during the consultation? Very Committed Somewhat Committed Not Sure Not Committed How soon are you looking to start implementing new financial strategies? Immediately Within the next 1-3 months Within the next 6 months Not sure Are you available to commit at least 1-2 hours per week for coaching sessions? Yes No Preferred Method of Consultation Phone Call Video Call (Zoom, Teams, etc.) In-Person (if applicable) Email Communication Please provide any additional information that you believe would be helpful for us to know before the consultation I understand that this consultation is for informational purposes only and does not constitute a client-coach relationship unless both parties agree to proceed with further services. I agree Would you like to receive updates and resources from ScaleUp Coaching Inc. via email? Yes No Submit
