Tri-County Council for Southern Maryland Business Survey
DICLOSURE: Full disclosure of financial and other proprietary information to Tri-County Council for Southern Maryland by the client is usually essential to provide effective assistance.  All clients are assured that such information is held in the strict confidence at all times and will not be disclosed to anyone outside the organization unless the client specifically authorizes this in writing prior to any disclosure.

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Part 1: Contact Information

Business Name:
Owner’s Name:
Alternate Contact Person:
Mailing Address :
City:
State:
Zip Code:
Phone:
Alternate Phone:
Fax:
Email:
Website:


Part 2: Business Background

Business Structure: Sole Proprietorship     Partnership     Limited Liability Co.     Corporation
Ownership:   Female    African American    Hispanic American    Native American  
Subcontinent Asian American   Asian Pacific American   Other

List any minority/women business certifications held (along with issuing agency):



Average Gross Revenue (for a typical year):
$100k       $101k - $500k      $501k - $1m       $1m - $4m       $5m

Years in Business: 1 year   1-5 years     6-10 years   11-15 years     16-20 years     20 years

Average Number of employees (for a typical year):  full time:       part time:



Type(s) of work performed:





If known, list the appropriate industry code/title (s) for your business (e.g. NAICS, SIC, etc):




Part 3: Business Assessment

Describe (by percentages) your major revenue sources.

% Private Small Businesses   %Large Corporation  %General Public 

%Government Local   State   Federal

Describe (by percentages) where you conduct business.

%Locally  %State-Wide  %Regionally   %Nationally %Internationally

How do you find clients/contracts?  Review Periodicals    Online Search Engine
                              Networking      Email Notification     Other

How do potential clients find you? Website     Direct Mail    Email Blast    Word-of-Mouth        
Paid Advertisement      Business Associations   Other

What business/professional associations are you or your firm a member? 


What is your single biggest business challenge?

Marketing    Access to Capital  Cash Flow    Accounting/Bookkeeping      Other


For 2009, where do you plan to focus your attention (check the most important)? 

Growing Revenue   Establishing Processes and Procedures for the Business    Hiring the Right Staff/Management Team

Positioning the Business for Sale    Other