If I cannot save your business money....you pay me NOTHING!


BizExec Client Questionnaire

Please fill out the following information so that we may understand more about you and your company.

General Information
Name of Company:
Company Address:
Zip Code: (5 digits)
Contact Information
Your First Name:
Your Last Name:
Your Position With Company:
Daytime Phone:
Mobile Phone:
Company Financial Information 
Is the Company Profitable? Yes No
Date Company Founded:
Annual Revenue (This Year): (USD)
Expected Revenue (Next Year) (USD)
Service Requested
Services Requested -

(Please Check all that Apply)
Consulting                    Profitability                 
Expense Control            Financing        
Manage Supply Chain    Raise Capital       
Operational Planning      Inventory Control  
Business Planning          Corp Governance 
Vendor Relations            Legal Review 
Marketing / Advertising  Loss Mitigation 
R&D Analysis / Planning Human Resources 
Information Technology Develop Organization
Take Company Public     Company Expansion

Other Services Requested
I authorize BizExec to contact me and that I have the authority to enter into an agreement with BizExec.