Full name *

First and last please
Phone number *

Email address *

Website address *

How did you hear about me? *

Please be specific
Briefly describe your business *

(using 3-4 sentences)
Which best describes your current situation? *

On average, how much income are you generating in your business monthly? *

This information will not be shared...it is strictly confidential

What are your business' strong points

(what's currently working)
What challenges are you currently facing in your business? *

On a scale of 1-10, (10 being highest priority), how committed are you to getting the results you want in your business? *

What results would you like to see in your business after working with me? *

Which best describes your financial resources?

If we decide we are a good fit to work together, how soon would you be interested in getting started?

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