Application Form

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

[phm-form]Name:

Best Phone Number:

Street Address:

City:

State:

Zip:

Type of Business:

Years in Business:

On a 1-10 (10= highest) scale, how satisfied were you with your responses to the Fill-in-the-Blank Challenge?

What was the toughest area for you?

What area was easiest?

What “burning question” do you have?

What does a “10” success in business look like to you?

What have you NETTED in your best month? And when was that?

What do you know you need to have in place in your business 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? And why?


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