REQUEST INFORMATION ABOUT THE BUSINESS

Welcome to our online "Quiz" - This helps me determine your interest level in gaining financial independence and time freedom.  I want to learn more about you and what you are looking for in a business - and what you would need from me to guide you in experiencing ultimate success.

I don't know you and I do not want to assume or guess about what you are looking to do with this business.  When I receive this form, completed in full - I will email and call you.  Please don't worry or get stressed by that - I am not going to push you into doing anything.  It's simply a chance for you and I to talk and get to know each other.  That way we will both know if we would like to work together.  I choose to work with positive, take charge, self-motivated people that have a serious interest in success and with consistent training and work are excited to create a six figure income online. 

I want to have fun and enjoy all the benefits of working from home and I am sure that is your mission as well - let's get started!

Please answer all the questions below:
Email:
First and Last Name:
Street Address:
City-State-Zip:
Phone (number must be valid):
How did you find me?:	Select One Online Ad Search Engine Message Board Referral Business Card Local Event
Are You Seriously interested in a Home Based Business?:	Select One Yes Of Course! Maybe No! I have no idea
Interest level based on knowledge thus far?:	Select One I'm a 10 - Let's Get Started! I'm a 7 or higher - more info I'm a 5 I have no idea
Have You Ever Owned a Home Business? :	Select One Yes No
Are You Willing to Commit to a Proven System and Be Coached & Trained by Those Already Successful?:	Select One Yes No
What Is Your Primary Reason For Wanting To Work From Home? Be Specific.:
What Interests You Most About This Particular Business?:	Select One The Product Retailing Fundraising Residual Income Low Start Up Costs All of the Above
What Is Most Important to You in a Home Business?:	Select One Ability to work from home using the internet Well established debt-free company To be coached-trained and shown exactly what to do Easy for anyone to do regardless of computer knowledge Unlimited Potential All of the Above I have no idea
Do You Have Previous Network Marketing Experience?:	Select One No-What is it? Yes-I have been involved in Network Marketing Before Never-but curious
Are You Currently Involved With Another Network Marketing Company?:	Select One No Yes-butI am interested in changing companies Yes-but I want to remain with my current company too I have no idea
Current Occupation or Company Affiliation::
Have You or Do You Want to Work with Leads? These Are People Whom You Have Not Met.:	Select One Yes-I have no friends left Maybe-let's talk about it If my friends say no-I'm not doing this I already use leads Whatever it takes
How Much Time Are You Going To Commit Per Week:	Select One 5-10 Hours 10-15 hours 15-20 hours Full-time
What Is Your Monthly Income Goal:	Select One $500-$1000 $1000-$5000 $5000-$10000 $10000 Plus
How Much Are You Willing to Invest to Get Started in Your New Business?:	Select One $200 $300 $500 $1000
Best Day to Contact You:	Select One Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Best Time to Contact You:	Select One Morning 9am-noon CST Afternoon noon-3pm CST Late Afternoon 3pm-5pm CST Early Evening 5pm-7pm CST Night 7pm-9pm CST
Comments:

Donna Vogel, Owner

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