You can always press Enter⏎ to continue
Free Strategy Call (Next Wellness)
Click Below to Begin Application
12
Questions
START
1
Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Email
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
3
Phone Number
*
This field is required.
Area Code
Phone Number
Previous
Next
Submit
Press
Enter
4
What is your business website (if applicable)?
Previous
Next
Submit
Press
Enter
5
What is your current monthly revenue?
*
This field is required.
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
More than $50,000 per month
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
More than $50,000 per month
Previous
Next
Submit
Press
Enter
6
What is your target monthly revenue?
*
This field is required.
Previous
Next
Submit
Press
Enter
7
What is your biggest obstacle to reaching your target monthly revenue goal?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
8
Describe your business
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
9
Do you have financial resources to invest?
*
This field is required.
I have the financial resources to invest
I have access to the financial resources to invest
I do not have access to the financial resources to invest
I have the financial resources to invest
I have access to the financial resources to invest
I do not have access to the financial resources to invest
Previous
Next
Submit
Press
Enter
10
If we determine this is a good fit, would you like to use our 3rd party funding to Fund the program?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
11
What is your annual income?
*
This field is required.
Less than $40k/year
More than $40k/year
Less than $40k/year
More than $40k/year
Previous
Next
Submit
Press
Enter
12
What is your credit score?
*
This field is required.
Less than 600
600-620
620-650
650+
Less than 600
600-620
620-650
650+
Previous
Next
Submit
Press
Enter
13
If you're accepted to work with Jared, how soon can you get started?
*
This field is required.
Previous
Next
Submit
Press
Enter
14
Please provide any additional information you think I should know before the call
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
14
See All
Go Back
Submit