1. First Name

2. Last Name

3. Primary Email

4. Home Phone or Cell Phone

5. What are your primary goals in business and in life?

6. What is your biggest challenge right now in reaching your goals? (be as detailed as you can.)

7. What do you do for a living? And/or what value do you offer?

8. What are your greatest strengths? what do you do well?

9. What is your current monthly revenue?

10. What would you like your monthly revenue to be?

11. How much have you invested in your online business education to date?

12. Do you have a website? if so, what is the domain?

13. How many hours per day can you realistically devote to building your Lifestyle Business? Select...No Time(I Want it Done for Me)Less Than 1 Hours Per Day1-2 Hours Per Day2-3 Hours Per Day3-4 Hours Per Day4+ Hours Per Day

14. What would it mean to you to be accepted to work with us as a case study?

15. If you had a 6, 7 or 8 figure business, what would you do with the money?

16. What is the best time to reach you? Please provide dates and times.(include your time zone)