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Small Business Survey
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* Indicates required question
Today's Date
*
MM
/
DD
/
YYYY
Time
*
Time
:
AM
PM
Business Name
*
Your answer
Business Owner
Your answer
Business Address
Your answer
Corporate Address
Your answer
Business Website
Your answer
Zip Code
*
Your answer
Phone Number
Your answer
Email
Your answer
Business Type
*
Dining
Bar/Nightclub
Retail
Medical
Internet
Auto Shop
Boutique
Gas Station
Utility Company
Religious
Political Organzation
Government
Other:
Required
How many customers come visit your small business location on a daily basis?
*
<10
10-20
20-30
30+
How many customers leave your store each day without purchasing, because they can’t afford your products or services?
*
1-5
6-10
10-20
30+
None
Do you currently have an active website for your business?
*
Yes
No
If so, is it making you money on a consistent basis?
*
Yes
No
Does not apply
Do you currently have an open small business line of credit that you use on a regular basis?
*
Yes
No
Do you currently have an existing merchant service provider?
*
Yes
No
Does not Apply
What do you dislike about your current processor?
*
Your answer
Are you on a Cash Discount Program with your current Processor
*
Yes
No
Are you experiencing any issues with employee absenteeism and/or lack of productivity due to financial stress at home and/or at the workplace?
*
Yes
No
N/A
Is your small business currently an active member of the local Chamber of Commerce in your community?
*
Yes
No
Do you constantly have to purchase new inventory on a regular and ongoing basis in order to replace old inventory that is not profitable for you?
*
Yes
No
Does your business have the capability to increase revenues without having to change your business model, inventory, hire additional employees and/or outside sales professionals, or increase your current advertising budget?
*
Yes
No
Do you believe that your customers spend more or less than 90% of their annual buying power at the major chain stores? (Walmart,Target,BestBuy,Mobil)
*
Yes
No
Does your small business profit when your customers shop somewhere else?
*
Yes
No
Thank you for participating in our survey today. The information you provided us will be invaluable as we begin reaching out to small business owners with practical solutions to the issues that are addressed in the survey. I am confident that my company will play an important role in helping local businesses increase revenues and overall profitability.
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