WSA Agency Application

1

Which of the following best describes your business?* This field is required.

My business provides a full income

My business provides a partial income

My business provides little to no income

2

Name* This field is required.

First Name

Last Name

3

Email* This field is required.

example@example.com

4

What is your website address?

5

What is your current monthly income?

$1k/month or less

$1k-$5k/month

$5k-$10k/month

Over $10k/month

6

What is your desired monthly income?* This field is required.

7

What is your biggest obstacle for hitting your monthly income goals??* This field is required.

8

Briefly describe your business, who you serve, what you sell and at what price point.* This field is required.

9

How willing and able are you to invest in the growth of your business right now?* This field is required.

I have financial resources to invest

I have access to the financial resources to invest

I do not have access to the financial resources to invest

10

If you get accepted to work with Halle Cottis, how soon can you get started?* This field is required.

11

Please provide us with any additional information that you think we should know before our call together.* This field is required.