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First Name

Last Name

Email

Phone

Business Name

Briefly describe your business.

How much money are you spending on advertising every month? How much money are you spending on advertising every month?Less than $1,000/month$1,000 - $2,500/month$2,500 - $5,000/month$5,000 - $10,000/monthMore than $10,000/month

What is your current monthly revenue? What is your current monthly revenue?Less than $1,000 Per Month$1,000 - $5,000 Per Month$5,000 - $10,000 Per Month$10,000 - $20,000 Per Month$20,000 - $50,000 Per Month$50,000 Per Month or More

What is your target monthly revenue? What is your target monthly revenue?$20,000 - $30,000 / Month$30,000 - $40,000 / Month$40,000 - $50,000 / MonthMore Than $50,000 / Month

What do you feel is your biggest obstacle at the moment?

How willing and able are you to invest in your business?

If you're accepted, how quickly can you get started?

Finally, what makes you different? Why should we work with you?

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