Business Questionnaire
1. Basic Information
Name of Company:
Your Name:
Title:
Address:
City:
Zip:
Phone:
Fax:
E-mail:
Nature of Business:
Married?
Yes No
Children?
Yes No
2. Business Structure
How is your corporation set up?
Corporation
Sub-S Corp
LLC
Sole Proprietor
Partnership
How many owners are involved?
How many employees do you have?
For the following list of programs, please signify whether you have such a program in place in your company already, or if not in place, have you ever considered it for your company.
Life/Health*/Disability* Insurance
Now in Place
Considered
Key Person Insurance - to improve benefits for selected employees
Now in Place
Considered
Income Replacement Plan* - to cover business expenses if you become sick or disabled
Now in Place
Considered
Buy-Sell Agreement - to provide an orderly way to assure the continuity of your business
Now in Place
Considered
Key Employee Plans - to protect the business if an indispensable employee dies or becomes sick or disabled*
Now in Place
Considered
IRS Qualified Plans - to provide tax deductible / tax deferred retirement benefits for you and your employees
Now in Place
Considered
A Salary Deduction Plan - to provide employees life insurance at competitive premiums via payroll deduction
Now in Place
Considered
How important do you feel the programs you now have in place are to the overall success of the business? Why do you feel that way?
How did you go about selecting the programs you now have in place?
For the following six areas of concern, please rate them, 1 as the most important to you, 6 as the least important. Please explain why you rated each of the concerns as you did.
Area of Concern
Rating
Reason for Rating
Retaining Key Employees
Continuation of the business at death, disability or retirement
Salary continuation if sick or hurt
Using before-tax dollars to fulfill personal objectives
Employee fringe benefits
How interrelated are your business and personal goals? How frequently do you review your personal financial goals and program?
Do you currently have any financial professionals other than a CPA or a lawyer? What services do they provide? Do they address both personal and business issues?
What characteristics do you look for in your financial professionals? What kinds of services do you expect?
Is there anything you would like to add which might help us improve member benefits from WBA Insurance Services in the future?