NextLevel Coach Solutions' Assessment & Financing Form
Complete and Submit this Form, to not only be assessed to Provide our Flexible Finance Programs; including the 100% Approval Rate Finance Regardless of Credit Program; but to be adequately assisted in elevating your practice or business to higher levels of performance, revenue, and profit.
Contact Name (Owner Only)
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First Name
Last Name
2nd Contact Name (If more than one Owner. If No 2nd Owner, place N/A in both fields)
First Name
Last Name
Business Name
*
Registered Corporate Name
DBA Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email ( Owner's best direct email)
*
example@example.com
2nd Owner's Email (If no 2nd Owner, write N/A)
example@example.com
Phone Number (Business)
*
Please enter a valid phone number.
Phone Number (Mobile)
*
Please enter a valid phone number.
2nd Owner's Mobile Number (If, no 2nd Owner, type 000-000-0000
Please enter a valid phone number.
Practice Specialty (Type)
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Do You Currently Offer Consumer Financing
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Yes
No
If You Answered Yes. Who are you using and what are your pain points with your current provider? Please be specific and provide as much information as possible. This way, we can help you in the very best manner possible. If you don't offer financing, type N/A.
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What are your three (3) Highest Ticket Packages? Include the service and package price and actual profit margin. NOTE: This information is highly important, because it will position us to strategize the most effective Traffic Marketing campaigns coupled with the best suited Finance Program. NOTE: Our goal with you is to maximize and continue to grow your revenue and profit, by any ethical means necessary.
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Current Monthly Financing Amount ($) (If not providing financing, write $0.
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Average Service/Package Ticket Amount ($) (Required for Eligibility and to provide you with the best financing options.)
*
Gross Annual Sales ($) (Required for Eligibility and to provide you with the best financing options)
*
Gross Average Monthly Sales during the previous three (3) Months ($) (Required for platform Eligibility)
*
Practice Establishment Date. ( To determine Eligibility to provide Consumer Financing).
*
State of Incorporation (To determine State Requirements and Eligibility).
*
Sales Process
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Face-to-Face
Online
Other
NextLevel Coach Solutions Agent's Name
NextLevel Coach Solutions Agent's #
Please verify that you are human
*
Submit
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