CPI Business Development Corp.
Division of Clean-Pro Industries, Inc.
Request for Consultation       Page 11-Request

Request for Consultation and Enrollment in CPI Programs and Courses

SUBMIT REQUEST BY FAX OR MAIL   (Please Print This Form Before Filling It Out)
Date
Name                                                                                                           Title
Name of Company
Street Address
City/State/Zip
Telephone No.                                                    Fax:                                                   e-mail:
Type of Business:  [   ] Service      [   ] Manufacturing      [   ] Retail      [   ] Wholesale     [   ] Other:
Type of Industry: 
Business Structure:  [   ] Sole Proprietorship     [   ] Partnership     [   ] Corporation      [   ] Limited Liability Co.
[   ] Subchapter S Corp.     [   ] Other:
What are your main concerns?  [   ] Business Management     [   ] Marketing     [   ] Sales 
[   ] Profitability     [   ] Finances     [   ] Planning     [   ] Vision/ Goal Setting     [   ] Operations 
[   ] Recruiting/ Hiring     [   ] Employee Development     [   ] Employ Turnover 
[   ] Stress from the Business     [   ] Organization/ Orderliness     [   ] Customer Service/ Complaints
[   ] Not Enough Time to Get It All Done     [   ] Not Taking Regular Vacations     [   ] Productivity 
[   ] Supervision     [   ] Team Building     [   ] Selling My Business     [   ] Other:
How many employees do you have?
What year was your business established?
What is your annual gross sales/revenue?  [   ] Under $100,000   [   ] $100,000 to $399,999 
[   ] $400,000 to $999,999     [   ] $1,000,000 to $1,999,999     [   ] $2,000,000 to $2,999,999
[   ] $3,000,000 to $3,999,999     [   ] $4,000,000 to $4,999,999     [   ] Over $5,000,000    [    ] Prefer not to say at this time
Would you like a business needs analysis?  (There is no charge)    [   ] Yes
Would you like us to send you our catalog of products,  services, and fees?  (There is no charge)   [   ] Yes
Would you like a brief consultation by phone?  (There is no charge for the first consultation)   [   ] Yes
Would you like an application to enroll in the Business Development Program?  [    ] Yes
Thank You for Your Interest In Our Products and Services

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