Business Worksheet

Please fill out the form below to the full extent of your abilities. The more information we obtain from you, the more we will be able to help going forward!

Do you have a business plan?

Do you have an entity in place (LLC, S-Corp, etc.)?

Do you have an accountant?

Do you use Quickbooks?

Do you have a current profit loss statement?

Are your taxes up to date?

Do you do your own payroll?

Do you have key person insurance?

Do you provide benefits to your employees?

Do you have employee retention issues?

Do you wish to retain a higher percentage of all qualified retirement contributions?

Do you have a buy-sell agreement in place?

Are you currently profitable?

Please describe any other business concerns below: 

Full Name

Preferred Contact Method





1840 5th St. Springfield, OR 97477  |  (O) 541-583-0093  |

Investment advice is offered through Belpointe Asset Management, LLC. Insurance and annuity products may be offered through D.H. Hill Securities, LLLP. Securities are offered through D.H. Hill Securities, LLLP, Member FINRA/SIPC. D.H. Hill Securities, LLLP, Todd Mann Financial Services Inc., and Belpointe Asset Management, LLC are not affiliated entities. Todd Mann Financial Services Inc. is currently insurance licensed in the states of Oregon, New Jersey, and Wisconsin.

Insurance and annuity products may be offered through D.H. Hill Securities, LLLP. 


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