Name:
Email Address:
Do you have a CD burner?	Yes No
How good are you with Excel?	I don't know how to use it I use it, but like a beginner I'm intermediate I'm an expert (crosstabs, pivot table, database)
Are you good at selling over the phone?	Yes No No, but I'm a good communicator, I can learn!
Do you currently have a blog at Blogger.com?	Yes No
Do you currently belong to an association or club that has at least 50 members?	Yes No
Is there more than 30 working women at the place where you currently work?	Yes No
Do you have experience running a business?	Yes No
How much money are you ABLE and WILLING to invest in a business opportunity, in order to become a business owner?	$100-199 $200-299 $300-499 $500-1,000
Which language(s) do you speak fluently?	French English Spanish Chinese (Mandarin) Japanese
Do you currently have and use a cell phone?	Yes No
Regarding your landline phone or your cell phone, do you have an Outgoing Message (this is the message that callers hear BEFORE they can leave a message in your voice mail box)?	Yes No
How many connections do you have on Linkedin? (www.linkedin.com)	I'm not registered on Linkedin 1-9 connections 10-29 connections 30-49 connections 50-100 connections 100-200 connections 200+ connections
Do you know exactly what the Cashflow Quadrant (invented by multimillionaire Robert Kiyosaki) is about?	Yes No
Would you like to walk 40 minutes per day and make money?	Yes No
Are you a good public speaker? Can you talk to a group of 4-12 people for an hour?	Yes No
Do you have consulting experience?	Yes No
One in 20 people ever achieve financial independence. Do you believe you have what it takes to become a successful business owner?	Yes No

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