Getting to Know You:

Full Name *

Phone *

Email *

Confirm E-mail *

City *

State *

About Your Business:

Business Name *

Years in Business *

What does your business do? *

Business Website

Is your business open? *

Yes! And I have customers

Yes, but no customers yet

No, my business is not open yet

Tell Us More:

Please rank your love of your business *

Select one

Love it!! My business is the best job ever
Most of the time I like it a lot
I am getting a little tired with my business
I am frustrated that I can't make my business work
Burn it down. I want out
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How would you rank your knowledge of business? *

Select one

1: I have exactly zero idea what I am doing
2: I know a little bit. But I am mostly making it up
3: I am not 100% sure what I am doing but I know enough to keep going
4: I am pretty confident in my business knowledge, I just need finessing
5: I know a lot about business and I know what I am doing with my business
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What top goals do you want to accomplish in the next 6-12 months? *

What has kept you from accomplishing these goals in the past? *

Are you taking other business classes/courses right now? *

Yes

Have you worked with a business coach before? *

Yes

Are You Ready?

How willing and ready are you to invest your time and energy into your own business? *

Select one

150% ready! I have been ready for years
100% ready. It is time. I am here for this.
85% ready. I am nervous but I am doing this
50% ready. Some aspects really scare me. I am trying to decide what is right.
20% ready. I just want to explore what starting a business looks like
0% ready. I don't have time, energy, or the money to step into my business right now
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If something was holding you back from investing in your business, what would that be? *

Concerns about money

Lack of confidence

Not knowing where/how to start

Finishing the right program

lack of support from family/friends

Other

Final Details:

Anything else you want us to know?

Referral/Coupon Code

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