Business Assessment

Your Next Step

We appreciate your interest in a free business assessment and we want to let you know all your information is private and confidential. We also limit the amount of free session to three a week. So, if you are serious so are we. We also understand we are asking you to invest in the time to totally feel out this form. We are totally committed in investing the time to give you the best hour your business. We need the information to find out more about you and to make sure you are invested in the hour. Things to understand:

• We will not sell your information or give it out
• You are not obligated to us for anything
• We will not pressure you
• You simply get one free hour to talk
• We will see if we can help you and if we are the right match

This hour is to ask questions of each other, to evaluate where your business is, to answer any of your questions, to see if you are ready for coaching, and to give you some ideas on how to improve your business.

“You have nothing to lose except one hour of your time and everything to gain from that hour.”

So take a chance you will be pleasantly surprised

*First Name:
*Last Name:
*Street Address:
*City or Town:
*State:	Other Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming
*Zip Code:
*Phone Number:
**Email Address:
Website URL:
*Company Name:
*Title:
*I first heard about you from:	...please select Google Yahoo MSN Other Search Engine Online Directory Friend/ Referral Letter Phone Book Other
*Please tell us a little more about the areas of your business that you want to experience the most results from?
*Why are you thinking about a coach/consultant now?
*What would you like to talk about in our session?
*Best Time to Call:
*Enter Code:

We will contact you to arrange a time to meet in person or on the phone.