Work With Mia Davies

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Welcome and congratulations for taking command of your financial future!

Simply fill out the questions below and I will be contacting you to set up an interview! You MUST leave your phone number and best time to call for me to get in touch with you!

I look forward to connecting with you!

To You Success,

Mia Davies
575.313.7374

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Please fill out the following information Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Country:
Email Address:
Phone Number:

Please rate yourself on a scale of 1-10 in the following areas (1=low, 10=high) Your ability to be coached?
Your ambition level?
Your belief in your ability to succeed?
Your belief in Network Marketing?

Work With Mia Davies

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1. Please fill out the following information

*
2. Best time to call

*
3. Age

*
4. What is your primary interest in pursuing this business opportunity?

*
5. How much income per month do you want to earn from your home based business?

*
6. Over what period of time would you like to achieve this income?

*
7. How much time can you devote on a weekly basis to achieve your financial goals and realize your dreams?

*
8. How much money are you able to invest in your business each month to grow your business?

*
9. On a scale of 1-10 how satisfied are you with your current level of income? (1= not at all, 10= very satisfied)

*
10. On a scale of 1-10 how would you rate your current level of commitment to realize your financial goals and dreams? (1= not committed, 10= very committed)

*
11. What do you think will be the greatest obstacle for you to overcome to achieve your financial goals and dreams?

*
12. Do you have any prior experience in a home based business or network marketing?

*
13. Please rate yourself on a scale of 1-10 in the following areas (1=low, 10=high)

Work With Mia Davies

1. Default Section

1. Please fill out the following information

*2. Best time to call

*3. Age

*4. What is your primary interest in pursuing this business opportunity?

*5. How much income per month do you want to earn from your home based business?

*6. Over what period of time would you like to achieve this income?

*7. How much time can you devote on a weekly basis to achieve your financial goals and realize your dreams?

*8. How much money are you able to invest in your business each month to grow your business?

*9. On a scale of 1-10 how satisfied are you with your current level of income? (1= not at all, 10= very satisfied)

*10. On a scale of 1-10 how would you rate your current level of commitment to realize your financial goals and dreams? (1= not committed, 10= very committed)

*11. What do you think will be the greatest obstacle for you to overcome to achieve your financial goals and dreams?

*12. Do you have any prior experience in a home based business or network marketing?

*13. Please rate yourself on a scale of 1-10 in the following areas (1=low, 10=high)

*
2. Best time to call

*
3. Age

*
4. What is your primary interest in pursuing this business opportunity?

*
5. How much income per month do you want to earn from your home based business?

*
6. Over what period of time would you like to achieve this income?

*
7. How much time can you devote on a weekly basis to achieve your financial goals and realize your dreams?

*
8. How much money are you able to invest in your business each month to grow your business?

*
9. On a scale of 1-10 how satisfied are you with your current level of income? (1= not at all, 10= very satisfied)

*
10. On a scale of 1-10 how would you rate your current level of commitment to realize your financial goals and dreams? (1= not committed, 10= very committed)

*
11. What do you think will be the greatest obstacle for you to overcome to achieve your financial goals and dreams?

*
12. Do you have any prior experience in a home based business or network marketing?

*
13. Please rate yourself on a scale of 1-10 in the following areas (1=low, 10=high)