Please provide the following contact information:

First Name
Last Name
Title
Business Name
Business Address
Address (cont.)
City
State/Province
Zip Code
Phone
FAX
E-mail
Web Site

What is the ownership of your child care operation?    Select_One Private Franchise Chain

What is the maximum capacity of your child care operation? 

What is your average vacancy rate?  %

Please check what kinds of payments do you accept and the corresponding percentage:
Cash: %     Check: %     Credit Card: %     ACH: %     Bill Pay Deposit: %

What percentage of your children receive a government subsidy for child care?  %

Do you require prepayment?  Yes   No

Please list your billing frequency options and percentage of revenue received:
Daily:  %      Weekly: %      Bi-weekly: %      Monthly: %

How many payments do you receive monthly? 

Have parents ever asked for AutoPay or Direct Pay?   Yes   No

How many NSF items do you receive each month? 
How do you handle NSF issues with parents? 

What percentage of parent do not pay on time?  %
How do you handle late payers: 

Do you charge for late pick-up of children?  Yes    No

Do you enforce your late payment policy?  Yes    No

Do you use a computer for in your business?    Yes    No

Do you have access to the Internet?    Yes    No

What software do you use to manage your operations? 

What person/position is in charge of billing, collections and deposits? 

What sources do you rely upon for ideas, information and tools related to operating a childcare business:
     Magazines/Journals: 
     Associations/Organizations: 
     Seminars/Training: 
     Consultants: 
     Other: 

Do you have the option of receiving Federal, State or other funding via Direct Deposit?  Yes  No
     If Yes, but choose not to, Why not? 

Do you employees have the option of being paid by Direct Deposit?   Yes    No

Would you pay them via Direct Deposit if available?   Yes    No

What are your initial opinions about accepting the following payment methods?

Credit Cards:        Too Costly     Too Complicated     No Knowledge     No Interest
Debit Cards:       Too Costly     Too Complicated     No Knowledge     No Interest
ACH:       Too Costly     Too Complicated     No Knowledge     No Interest
Bill Pay Deposit:       Too Costly     Too Complicated     No Knowledge     No Interest

Would you like to learn more about ACH/Direct Payment for your business?   Yes    No

Would you like us to send you a summary of our survey findings?   Yes    No

Please use the space below for any questions or comments.

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