First Name
Last Name
Phone
*
Email
*
Business Name
Website
Social Media
Your Business
Where are you currently in your business?
Just getting started
I have a business idea
Less than 1 year
1–3 years
3+ years
What type of business do you have?
Service-based
Product-based
Coaching / Consulting
Real Estate
E-commerce
Other
What is your biggest challenge right now?
Mindset
Branding
Creating an offer
Content
Getting leads
Sales
Systems
Automation
Customer experience
Scaling
Leadership
Other
Your Goals
What are you hoping to accomplish through Empire Built?
Why are you looking for mentorship right now?
What would make this mentorship a successful experience for you?
Readiness
How ready are you to take action in your business?
I'm just exploring
I'm researching my options
I'm ready to take action
I'm ready to make significant changes
How committed are you to implementing what you learn?
I'm still figuring things out
I'm willing to learn
I'm committed to implementing
I'm fully committed to doing the work
What is the biggest thing holding you back from reaching your next level?
Discovery
How did you hear about Empire Built?
Facebook
Instagram
Website
Referral
Webinar
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Is there anything else you'd like us to know?
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