Name
First Name
Last Name
Email
*
Message
What are you looking to do with your business?
*
Grow
Same
Survive
Close
Has your clients increased or decreased in the last year?
*
Increased
Same
Decreased
Are your services or products unique?
*
Yes
No
Partially
Do you own the intellectual property for your product or service?
*
Yes
No
Partially
In the last year has competition....
*
Increased
Remained the same
Decreased
Is your client base regular or irregular?
*
Small number REGULAR
Large number REGULAR
Small number IRREGULAR
Large number IRREGULAR
Have you recently lost a major client?
*
Yes
No
Do you offer more than one product or service?
*
1
2
3
4+
Do you have a clear value proposition relative to your competition?
*
Yes
No
Unsure
How long does it take for your customers to pay your invoices?
*
At POS
< 30 days
Between 30 & 60 days
> 60 days
Do your customers often dispute payment of your invoices?
*
Yes
No
Have you lost any critical staff in the last 12 months?
*
Yes
No
Are you up to date with staff payments and superannuation payments?
*
Yes
No
Do you have enough staff?
*
Yes
No, cannot afford more staff
No, cannot find staff
Are you holding a large amount of stock?
*
No, struggling to get supplies
No, stock turning over quickly
Yes, need to hold a large variety of stock
Yes, sales are slow
Do you owe money for unpaid BAS and/or PAYG?
*
Yes
No
Are you in arrears with your landlord?
*
Yes
No
Do you have 1 or more critical suppliers that represent more than 25% each of your business?
*
Yes
No
Would you describe your suppliers as loyal?
*
Yes
No
Not sure
Are any of your suppliers currently chasing you for payment?
*
Yes
No
Have you any current final demands for payment?
*
Yes
No
Are you experiencing stock supply issues at the moment?
*
Yes - short term problem
Yes - long term problem
No
How easy would it be to change main suppliers?
*
Impossible
Difficult
Possible
Easy
Do you have any bank finance (overdraft, business loan)?
*
Yes
No
Do you have any business loans from non bank lenders?
*
Yes
No
Are you behind on any loan repayments?
*
Yes
No
Is there any litigation or legal action against your company?
*
Yes
No
