Please Complete ALL of the fields below: First & Last Name: Phone: Best time to contact City & State Email Address Why are you looking to start a business? What skills do you have that you believe will make you an asset to our Team? Leadership Presenting & Training Ability Direct Marketing Experience Business Ownership Experience Desire & Commitment What is your monthly income goal? less than $500 $501 - $1,000 $1,001 - $$5,000 $5,001 - $9,999 $10,000+ How much are you willing to invest to start your business? $250 - $499 $500 - $749 $750 - $999 $1,000 - $1,499 $1,500+ How much time can you spend building your business WEEKLY? 1 - 5 hours 6 - 10 hours 11 - 20 hours 21 - 40 hours 40+ hours How soon are you looking to start? immediately within 48 hours within 7 days within 2 weeks within 30 days Once I have full information, I make decisions quickly. True False I believe I deserve to be financially independent. True False

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