Application Form

Please fill out these questions and I’ll be in touch with you within 24 hours!

[phm-form]Name:

Best Phone Number:

City:

State:

Type of Business:

Years in Business:

On a 1-10 (10= highest) scale, how satisfied are you with where you are along the sequential path to building your business?

Which phase are you “located” in at the moment? (Your location is on the earliest completed step.)

Which phase are you dreading the most?  

Which phase do you feel most excited, most competent to do well in?

What do you know you need to change to have the success you want?

On a 1-10 scale, to what degree do you follow-through on ideas, advice, your own intentions/plans, etc?

On a 1-10 scale, to what degree do you “do what it takes” to reach your goals?

On a 1-10 scale, how committed are you right now to following-through and doing what it takes?


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