Work With Me Form

Nicole Gall | [email protected]

First Name

Last Name

Instagram/TikTok Handle

Email *

Phone *

Please enter a valid phone number

Click on each of the following statements that applies to you

I have not yet tried Plexus

I have tried Plexus in the past but was not consistent

I use Plexus but have not become an Ambassador

I have Plexus Shipped to me monthly

What are some of you health goals? Click all that apply:

Gut Health or Autoimmune issues

Detox, Jumpstart/Reset

More Energy

Weight Loss

Better Sleep

Better Digestion

Better Immune Health

Clearer Skin

Better Nutrition

More Exercise

Mental Focus and Clarity

Reduced Inflammation or Pain

Improved Mood

Stronger Hair and Nails

More Hydration

Other

Is there anything else you would like me to know about your health goals?

Age

18 - 25

26 - 34

35 - 44

45 - 54

55 - 64

65+

Are you currently working with a Plexus Ambassador?

Yes

Gender

Male

Female

What are your main reasons you want to work with me?

Looking to diversify/supplement my income

Stay at home Mama (or would like to be)

Option I am busy - I would like to increase my income to have more time freedom

I have huge gold to help a ton of people

I want to be involved and make new friends

I want to work on my health and wellness while making money to at least get my products paid for.

Which best describes you:

Motivated by fun and recognition

Motivated by helping others being part of the cause

Motivated by order, timeliness, facts and figures

Motivated by challenge, goal or leadership roles

Motivated. by money

Which best describes your goal

Earn enough income to cover the cost of my products

Earn an extra $500 month to help with bills or savings

Build a business making 50,000+ each year

I want to go to the TOP and am ready to full force to get there

Which best describes you

Stay at home mom or dad

Student

Unemployed

Employed Full-time

Employed Part-time

Work from home

Own my own business

READY TO CHANGE MY LIFE

Are you Coachable & Hungry?

Are you a self starter, independent and good with people? It's totally ok if you're not. I can help you in this area.

What is the best way for me to contact you?

Text message

Facebook message

Phone call

In 2-4 sentences, tell me WHY you think you would make a GREAT addition to my team!

Option 1
Option 2
Option 3
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