Mr. Ms. Miss Mrs.      First Name:        Last Name:

Title:         Company:      

Industry:      Company Size:  Just Me 2 - 5 6 - 10 11 - 19 20+

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City:       State/Province:       

Country:   United States Canada France U.K. Other

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I am a: Pre-Entrepreneur Small Business Owner Mid-sized Business Owner Solo Professional

I primarily need help with:   Administrative Support

                                        Marketing Support

                                        Customer Support

                                        Vendor Relations

                                        Complete Office Solution

                                        Copywriting Services

                                        Follow-up

I also need help with:           Administrative Support

(Check all that apply)           Marketing Support

                                        Customer Support

                                        Vendor Relations

                                        Complete Office Solution

                                        Copywriting Services

                                        Follow-up

Time each week spent on non-core, or administrative tasks:

                                        1 - 2 hours per day (5 - 10 hours per week)

                                        3 - 4 hours per day (15 - 20 hours per week)

                                        I spend one day per week on admin tasks

                                        I spend my weekend on admin tasks

                                        I don't keep up with my admin tasks!

In a typical week I need help with the following tasks:

With additional assistance I could: 

                                                 Expand my business/Increase revenue

                                       Increase customer satisfaction

                                       Reclaim my personal/family time

                                       Other:

Special applications, equipment, etc. used:

                                                 For example, Top Producer, Lotus, etc.

I need a better way to:        Collaborate with offsite team members

                                       Stay connected with my office while traveling

                                       Make data available to clients

                                       Remain accessible to clients

                                       Track billable hours

                                       Handle financial reporting

                                       None of the above

Work Style Questions

Organization:                          I am ultra organized.  I file everything.

                                         I am fairly organized.

                                         I often find it difficult to locate important info.

Collaboration:                         I am the quintessential team player.

                                       I work fairly well with others.

                                       I prefer to work independent of others.

Flexibility:                                I adapt to change easily.

                                       It takes time for me to accept change.

                                       I hate change.

Delegation:                             I delegate tasks to others readily.

                                      I just find it easier to do it myself.

                                      If I want it done right I have to do it myself.

Focus:                                      I remain focused and complete all tasks on time.

                                      I sometimes get distracted by phone, email, etc.

                                      I have several incomplete projects on my desk.

Problem solving:                   I often think outside the box to solve problems.

                                      I usually stick to what's worked in the past.

                                      If it's not broke, don't fix it.

My top priority is finding a solution to:

I need help:                          Immediately.

                                      Within 30 days.

                                      Within 6 months.

                                      I am preparing for next year.

Additional comments: