Your Business Success Builder
Please complete and return this Business Success Builder as soon as possible.
This questionnaire is designed to accomplish 3 things:
1) to help you get more focused for your session
2) to help you pre-think so that your session will be more productive
3) to allow us to customize the session for you to help you achieve your dreams and goals more efficiently and quickly.
The Business Success Builder includes two sections
Section 1: General questions about your goals and ownership/leadership style as well as more specific questions relating to your business.
Section 2: Prioritizing your challenges and opportunities.
Please note that this form is dynamic, in other words if you leave this page your information is not saved.
Please complete in one sitting.
It is important for you to be as honest and accurate as you can. Please complete both sections.
Section 1
Section 2
Please Pick Your Top 5-7 Priorities Below
Congratulations and thanks for your time …

Thank you for taking the time to complete this questionnaire … it’s really important for
both of us to fully understand your current situation …that way we can be sure to put our effort into the areas of your greatest importance.
If you chose the printed version of this form:
Please Fax to 828-395-1801
or e-mail to williamgilliland@actioncoach.com.
Bill Gilliland
P.O. Box 238,
Montreat, NC 28757
828-348-1787
Confidentiality Note
The information contained in this questionnaire is confidential information intended only for the use of ActionCOACH and the person completing this questionnaire.
If the receiver of this questionnaire is not the intended recipient, the receiver is hereby notified that any
dissemination, distribution, copy, or publication of the questionnaire is strictly prohibited.