Purpose: Help business owners identify if they’re ready to grow, need a tune-up, or should consider restarting smart with support from Dr. Shanté of Bluestone Capital Group.

First Name *

Last Name *

Email *

Phone *

Address

Street Address

City *

State *

Country

Postal code

Business Name *

write NONE if not applicable

🧠 Section 1: Smart Foundation Check (Chapters 1 & 2)

Do you have an Employer Identification Number (EIN)?* *

Yes

No

I'm not sure

Have you officially registered your business with the state?* *

Yes

No

Are you an unincorporated entity? *

Yes

No

I'm not sure

Which of the following best describes your business structure? (Select one) *

Do you have foundational documents in place? (e.g., Articles of Incorporation, Operating Agreement, Bylaws) - please check all that apply *

Do you have a clear mission statement for your business?* *

Yes

No

Have you ever stopped or restarted your business before? *

Yes

No

Would you like to receive personalized feedback from this diagnostic? (Required to collect email)* *

Yes, send to my email

No thanks

💰 Section 2: Financial Fortification (Chapters 3 & 4)

Do you have a separate business bank account (not personal)? * *

Yes

No

If you have a business bank account, approximately how much money is being deposited into your business bank account each month?* *

Do you use a system to track income and expenses (e.g., QuickBooks, bookkeeper)? * *

Yes

I do it manually

No, not at this time

If Yes or manually, please share your system to track income and expenses.

Do you file your annual report or compliance documents each year? * *

Yes, I do it myself

Yes, I have a 3rd party file on behalf of my business

No

Do you have a working business budget or financial forecast? * *

Yes

No

I started one but didn't finish

📬 Section 3: Credibility & Professional Image (Chapters 5–8)

Do you have a Merchant Service Account? * *

Yes

No

Which Merchant Service do you use? (Select all that apply) * *

Stripe

Square

PayPal

Other Merchant Service Provider

If you selected Other Merchant Service Provider, Please name it here *

Do you use the following payment methods as a "Business" e.g. CashApp/Zelle? * *

Yes, I accept CashApp to a Business Bank Account

Yes, I accept Zelle to a Business Bank Account

I do not use either of these with a business bank account

How do you currently accept payments? *

Do you accept cash or checks? *

Yes, I accept both

I only accept cash

I only accept checks

Do you use a business phone number (not your personal cell or google voice)? * *

Yes

No

Do you have a business email address (e.g., [email protected])? * *

Yes

No

May also be admin@ or yourname@

What type of address do you use for your business? (Select one) * *

Virtual Mailbox / Business Address

Physical office or retail space

My home address

I don't have a formal address at this time

📈 Section 4: Visibility & Planning (Chapters 9 & 10)

Do you have a website or landing page for your business? * *

Yes

No

Do you currently have a written business plan? * *

Yes, it’s updated

Yes, but it's not updated

I started one but haven’t finished

I don't have one

💳 Section 5: Credit to Capital Readiness (Chapter 11)

Is your personal credit score 650 or higher? * *

Yes

No

I'm not sure

Is your business registered with D&B, Experian Biz, or Equifax Business? * *

Yes

No

I'm not sure

Do you have business tradelines (credit cards, vendor accounts, etc.)? * *

Yes

No

I'm not sure

Do you have a digital file or folder with all of your business documents ready? *

Yes

No

Do you own real estate property or would you like to own property? * *

No/Not at this time

No, but I would like to buy a home

No, but I would like to buy an investment property

Yes, but I would like to buy more property

Let's Learn More About You...

Please select your Age range *

What best describes your current situation? (Select one) *

Do you have any specific challenges or goals you’d like to share? *

May type "NONE"

How would you prefer to be contacted? (Select one) *

Would you like to learn more about business coaching with Dr. Shanté through Blue Stone Capital Group? *

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