Comments/Questions:

Tell us about yourself:

How did you hear about us?

Email Choose One AD Banner Google Yahoo Other Search Engine Magazine AD Flyer Personal Referral Telephone Flyer / Insert Other

If other:

Choose One Excel ACN Fortune Hi Tech 5Linx Nexx Quixtar Other

If other:

On a scale of 1-10 (10 being Extremely Serious), please rate your seriousness about owning your own home business:

Choose One 10 7-9 4-6 1-3 0

Have you ever had a home based business?

Choose One Yes No

If yes, please give us some details:

What is your main reason for considering owning a home based business?

Choose one or more:

Choose one Work from home Time freedom More money Lifestyle freedom Career change Retirement Other

If other:

How much monthly income would you like to earn in your home business?

How many hours per week would you be able to commit to working your business?

Choose One Less than 5 hours a week 5-10 hours per week 10-25 hours per week 30 or more hours per week

How much money do you have to invest in building your business?

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