90 Day Challenge Pre-Qualification Form

1
AGENT NAME* This field is required.
First Name
Last Name
2
AGENT ID?:* This field is required.
3
HAVE YOU BEEN A 1-800-BIZ-FUNDS DAC AGENT FOR AT LEAST 30 DAYS?* This field is required.
Yes
No
4
CLARIFY WHAT PULLED YOU INTO THE 90-DAY CHALLENGE — WHAT EXACT MOMENT MADE YOU SAY “I NEED THIS”?* This field is required.
5
LET US KNOW THE INCOME YOU REALLY WANT — NOT THE SAFE NUMBER, THE ONE YOU’RE AFRAID TO SAY OUT LOUD.* This field is required.
$50,000 or less
$50,000 - $100,000
$100,000 - $1,000,000
$1,000,000 or more
6
OBSERVING YOUR PAST ACTIONS, WHAT HAS CONSISTENTLY STOPPED YOU FROM HITTING YOUR CASH FLOW GOALS, AND WHAT EFFORTS HAVE FAILED YOU?* This field is required.
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Ok
Ok
7
SHARE WHAT IT WOULD MEAN FOR YOU — AND THE PEOPLE WHO DEPEND ON YOU — IF YOU FINALLY HIT YOUR CASH FLOW GOALS.* This field is required.
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Ok
Ok
8
EXPOSE ANY CONCERNS, FEARS, OR DOUBTS YOU HAVE ABOUT THE CHALLENGE SO WE CAN ADDRESS THEM TOGETHER.* This field is required.
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Ok
Ok
9
REGARDING SCHEDULING, WHICH TWO DAYS AND TIMES CHOICES ARE YOU AVAILABLE FOR YOUR 90 DAY CHALLENGE PRE-QUALIFICATION CONSULTATION SO WE CAN GET YOU MOVING?* This field is required.
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Ok
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