IJ Clinic on Entrepreneurship - Potential Client Survey

Please complete the form below, so we can learn more about you, your business, and your legal needs. Remember, the more information you can give us, the better we can determine whether or not we can assist you.

  1. Your Contact Information

  2. First Name(*)
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  3. Last Name(*)
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  4. Suffix
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  5. Title
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  6. Company
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  7. Address 1
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  8. Address 2
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  9. City
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  10. State
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  11. Zip
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  12. Email
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  13. Work Phone
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  14. Home Phone
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  15. Mobile Phone
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  16. Fax
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  17. Website
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  18. Gender
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  19. Race
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  20. Neighborhood
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  21. Business
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  22. Business Address
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  23. City/State/Zip
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  24. Would you like to receive information from the Institute for Justice Clinic?
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  25. Have you attended any classes on entrepreneurship yet?
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  26. Have you started a business before?
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  27. How did you hear about the IJ Clinic?
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  28.  
  29. Founder Information

    Now, we’d like to know a little more about the owners of your business. How many people own your business? Please complete the information below for each business owner.

  30. How many people own your business?
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  31. Founder 1

  32. First Name
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  33. Last Name
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  34. How many people are in your household?
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  35. What was the income for the entire household in the most recent tax year?
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  36. Have you taken a business planning class?
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  37. Founder 2

  38. First Name
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  39. Last Name
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  40. How many people are in your household?
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  41. What was the income for the entire household in the most recent tax year?
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  42. Have you taken a business planning class?
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  43. Founder 3

  44. First Name
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  45. Last Name
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  46. How many people are in your household?
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  47. What was the income for the entire household in the most recent tax year?
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  48. Have you taken a business planning class?
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  49. Founder 4

  50. First Name
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  51. Last Name
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  52. How many people are in your household?
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  53. What was the income for the entire household in the most recent tax year?
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  54. Have you taken a business planning class?
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  55.  
  56. Business Information

  57. Tell us more about your business or idea
  58. Business Name(*)
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  59. Address 1(*)
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  60. Address 2
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  61. City(*)
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  62. State
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  63. Zip(*)
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  64. Phone
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  65. Description
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  66. Is the business in operation?
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  67. How many people currently work in your business (including yourself)
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  68. If the business is already in operation, please answer these questions:
  69. What was the total revenue of the business for the most recent tax year?
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  70. What is the current average monthly revenue for the business?
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  71. What was the business' profit/loss for the most recent tax year?
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  72. What is the current average monthly profit/loss for the business?
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  73. Do you have a written business plan?
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  74. What are the financing requirements of your business?(*)
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  75. How do you plan to finance the business?




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  76. Please explain
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  77. What are your business' legal needs?
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  78. Is there any other assistance you are seeking for your business?
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Email Address
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Institute for Justice
901 N. Glebe Road, Suite 900
Arlington, VA 22203
Tel 703.682.9320, Fax 703.682.9321
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