Elite form

DESCRIPTION:"Due to high demand, we accept only 12 elite clients per month. Apply only if you are fully committed to a private, AI-powered habit transformation. This program is exclusively for high-net-worth individuals who seek a discreet, highly effective solution to quit smoking, alcohol, gambling, or other addictions. Please answer all questions honestly and completely."

1-"Name"*

First NameLast Name

2-"Email"*

example@example.com

3-"Which Elite Habit Transformation Are You Seeking?"*

Stop Smoking AddictionStop Alcohol AddictionStop Gambling AddictionOther

4-"What’s your ultimate reason for breaking this habit?"*

(Health, Family, Peak performance, etc)

5-"How fast do you want your transformation?"*

Within 30 DaysWithin 60 Days

6-"Your health and legacy are priceless. Are you ready to invest in your elite transformation?"*

I’m fully committed to investing $100,000 for a private, high-performance 30-day elite transformation experience.I’m fully committed to investing $200,000 for a private, high-performance 60-day elite transformation experience.

7-"If you don’t action now, what will your life look like in 5 years?"*

(Health risks, Strained relationships, Lost career opportunities, Mental struggles, Financial setbacks)

8-"What is the biggest challenge stopping you from quitting this habit?"*

(High-stress lifestyle, Social pressure, Fear of failure, Lack of structure plan, Emotional triggers like anxiety, depression, or past trauma, etc.)

9-"Are you ready to make a powerful decision to transform your life today?"*

Yes, I’m fully prepared to invest in my elite transformation now.

10-"Select your preferred payment method to complete your investment in Elite Habits Reset AI."*

PayoneerStripeBank Wire Transfer