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..Questions about this form?

Phone us at (312) 324-0274

USALC Chicago National HQ

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Mr. Ms. Mrs.    First Name:     Last Name:   

Company Name:         

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Website (required): 

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First year of revenue generation (must equal 1 year or older):   ... 2010 2009 2008 2007 2006 2005 2004 2003 2002 1995 - 2001 1990 - 1995 1980 - 1990 1970 - 1980 Before 1970   

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Number of staff that are compensated, including yourself (must equal 1 or more):   ... 1 2 to 4 5 to 9 10 to 19 > 20

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Postal Zip Code:    

Most significant financial area of improvement:  sales/marketing donations/contributions other    

If 'other,' please describe: 

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What is the unit of measurement that defines success in this area:  $ of revenue other   

If 'other,' please describe: 

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What is your time measurement for success:  per day per week per month per quarter per year

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What is your current level of success in this unit of measurement? 

Must be greater than $0: 

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What is your desired level of success in this unit of measurement? 

Must be greater than $0: 

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How important is this goal to your company's long term success?  10% 20% 30% 40% 50% 60% 70% 80% 90% 100%    

Describe the activities that you plan to implement in order to achieve the stated goal.

What type of marketing, financial, or business strategy planning assistance can USALC provide that can help you achieve the above stated goal?

USALC incurs significant marketing, training, and other administrative costs to facilitate high-quality 50-hour, 3-month consulting experiences for our partners. Our consultants subsidize 80% of these costs. Is the professional need you described above worth our consultants' considerable time and financial support?   Yes     No