First name
*
Last name
*
Telephone number
*
E-mail Address:
*
Street address
*
City
State
Country
*
Zip / postal code
*
Preferred method of contact
*
Telephone
Email
Best time to contact you
*
Morning
Afternoon
Evening
Weekend
Sex
Male
Female
Age
18 to 25
26 to 35
36 to 45
46 to 55
56 to 65
65+
How did you find out about our website?
*
Friend / referral
Email link
Website link
Search Engine
Classified advert
Flyer
If you selected friend / referral above, what is the name of the person who referred you?
*
Do you now, or have you ever owned your own business?
*
Yes
No
If yes, what type of business did you own?
What would be your number 1 priority in starting a home business?
*
Extra income
Financial freedom
More spare time
Own a business
Leave a legacy
Retirement
Meet new people
Helping others
Personal development
How much money would you be looking to earn each month from a home business?
*
£50 to £250
£250 to £500
£500 to £1000
£1000 to £2000
£2000 to £5000
£5000+
How would you spend any extra income generated by your business?
*
Pay extra mortgage payments
Save for children’s education
Pay off credit card debt
Take a vacation
Buy your dream car or home
Investments
Other
How serious are you about starting a home business?
*
very serious
Somewhat serious
Just researching
If this program meets your expectations, when would you be ready to get started?
*
Right away
In the next week
In the next month
In the next year
How many hours per week would you be willing to commit to a home business?
*
5 to 10 hours
10 to 20 hours
20 to 30 hours
30 to 40 hours
40+ hours
As you know, a business takes money to start and to run. If this is the right opportunity for you, how much capital would you be willing to invest?
*
£50 to £100
£100 to £200
£200 to £500
£500 to £1000
£1000+
Not willing to invest
What other information would you like us to consider when we contact you?
Do you have any other specific questions you would like us to answer?
Required
*
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