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$100K Breakthrough Session Form
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16
Questions
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1
Hello, what's your name?
*
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2
What's your email?
*
This field is required.
We will never spam you. We use this as our main way to communicate and deliver your Breakthrough Session info!
example@example.com
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3
What's your company's name?
*
This field is required.
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4
Where is your business based?
*
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USA
Canada
UK
Other
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5
What type of business do you have?
*
This field is required.
If you are starting a business, what type of business will it be?
Service
Brick & Mortar
Ecommerce
Software
E-Learning
Other
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6
Please describe your business in 1-3 sentences *MAX.*
*
This field is required.
example: I help realtors attract more buyers on instagram for $1500/month.
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7
What are your main company goals? Be specific.
*
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8
Who is your ideal target customer?
*
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Be specific.
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9
How many employees do you have?
*
This field is required.
It's just me
2 - 10
10 - 50
50 - 100
100 - 200
200 - 500
500+
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10
What is your annual revenue?
*
This field is required.
$0 - $500k
$500k - $1M
$1M - $3M
$3M - $5M
$5M - $10M
$10M+
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11
How much profit did your business earn over the past 12 months?
*
This field is required.
$0 - $250K
$250K - $500K
$500K - $750K
$750K - $1M
$1M - $3M
$3M - $5M
$5M - $10M
$10M+
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12
How much profit did your business earn over the past 3 months?
*
This field is required.
$0 - $250K
$250K - $500K
$500K - $750K
$750K - $1M
$1M - $3M
$3M+
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13
What's motivating you to get help?
*
This field is required.
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14
What are your biggest pain points or challenges currently?
*
This field is required.
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15
What is your website?
*
This field is required.
Example: www.experiencescale.com
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16
What's your phone number?
*
This field is required.
We will use this during your Breakthrough Session!
Please enter a valid phone number
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