Name *

First

Last

Email *

Phone Number *

Business Name *

Describe your business: Who do you help & what are the primary benefits you deliver for your clients and customers? *

Your Business URLs: Feel free to include blogs, Facebook Fan pages, YouTube Channels and product pages (if you have them): *

Your total annual income:

Percentage of your total income you make from the business we will be working on:

What is your income goal?

The 3 most important goals that would make the biggest difference in your business over the next 180 days.

Why would you be an amazing addition to this group?

On a scale of 1-10 how committed are you to making your business a success in the next 180 days?

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