1. Full Name

2. Email Address

3. Phone Number

4. Website

5. Skype User ID

6. Do you own your own business?

Yes
No

7. What type of business do you own?

8. Is your business growing, declining, or plateaued?

Plateaued
Growing
Declining

9. Do you have an email list?

Yes
No

10. What size is your email list? (if applicable)

Under 2,500
2,500 - 5,000
5,001 - 10,000
10,001 - 20,000
20,001 - 50,000
Over 50,000

11. Your Current MONTHLY Business Revenue

Not making any money
$1,000 - $5,000
$5,001 - $20,000
$20,001 - $50,000
$50,001 - $100,000
Over $100,000

12. Are you satisfied with your present business revenues?

13. On a scale of 1 to 10, how important to you is it to get customers/clients from advertising?

1
2
3
4
5
6
7
8
9
10

14. How much do you spend on paid advertising every month?

I do not run paid ads
Under $3,000
$3,001 - $5,000
$5,001 - $10,000
$10,001 - $30,000
Over $30,000

15. What is the time frame in which you would like to achieve these goals?

30 days
3 to 6 months
6 to 9 months
9 to 12 months

16. What major challenge do you need help with?

(Please be as detailed and specific as possible.)

17. Is there anything else you would like us to know?

Website