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First Name:
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Address:
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Occupation:
Amount you can Invest?
Limited Amount
Moderate Amount
Large Amount
Not sure yet
Best Day to Call?
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Anytime is fine
Weekdays are good
Weekends are fine
Best Time to Call?
Morning
Afternoon
Evening
Income Desired per month?
$300-500
$500-1,000
$2,000-5,000
$7,500-10,000
$10,000 ++
How did you hear about us?
Friend
Family member
Acquaintance
Co-worker
Card
Newspaper ad
TV
Radio
Magazine
Flyer
Email
Internet search
Web banner
Other
What is your interest level?
I’m ready let’s go
Extremely interested
Moderately interested
Have questions
What's #1 reason for your interest?
My job does not pay enough
I may get downsized
I want more time with my kids
I need more money to retire
I own a business but want freedom
I want a better home based opportunity
I want a franchise without the high cost
I am in healthcare but want to help more
I am tired of only getting paid when I sell
I just want a better life
What Are you most interested in:
The Product
The Business
Both
Not sure yet
When Can You Start?
Right Away
1-3 months
3-6 months
Not Sure
Your Time Available?
1-10 hours per week
11-20 hours per week
21 + hours per week
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