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1

When it comes to managing your personal finances,what’s the single biggest challenge, frustration or problem that you’ve been struggling with?* This field is required.Please be as detailed and specific as possible.

2

Which of the following best describes your age?The reason for asking is because knowing your age will help us better serve you.

Under 20 years old

20's

30's

40's

50's

60 years old or above

3

Which of the following best describe your working status?The reason for asking is because knowing working status will help us better serve you.

Working in the corporate envirnoment

Working in your own business

Not working at this moment (because of any reason)

4

If you are planning to sort out your financials, which of the following areas would be of the priority for you?The reason for asking is to prioritise your needs, which will help us better serve you.

Budgeting and Savings

Debt consolidation

Purchasing your first / dream home

Investing in real estate or other options

Something else (banking, insurance, retirement etc.)

5

If we were to create a paid program (product or service) on one of the above listed topics and you had to choose one, which of the following are you most likely to have signed up for if it was already available?

One-on-One Coaching

Online Course

e-Book

Membership

Honestly, none of the above

6

Last Step: What’s your best contact information so I can get you scheduled for 45 minute FREE Consultation and make sure you’are notified about that on time.

First Name

Last Name

7

What's your email address?

example@example.com

8

Phone (Optional)Lastly, I may wish to follow up with a few people on the phone personally to better understand your situation. Would you be open to speaking on the phone for a few minutes on the condition that I promise not to sell you anything? If so, would you please leave your phone number below? Thank you!

Area Code

Phone Number

9

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