1.  How ambitious are you?

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2.  How motivated are you to build a home-based business?

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Have more time for family

3.  What are your priorities? 
Most Important
Select One I need more income I want to work at home I want to create retirement income I want to spend more time with my family I need more security I want the tax benefits of a home business I'm out of work and looking for a new career I have pressing debts I want to pay I want more freedom and control over my life
Secondary Importance
Select One I need more income I want to work at home I want to create retirement income I want to spend more time with my family I need more security I want the tax benefits of a home business I'm out of work and looking for a new career I have pressing debts I want to pay I want more freedom and control over my life
Third Importance
Select One I need more income I want to work at home I want to create retirement income I want to spend more time with my family I need more security I want the tax benefits of a home business I'm out of work and looking for a new career I have pressing debts I want to pay I want more freedom and control over my life

4.  How strong do you feel about protecting the environment?  (10 = very important, 1 = not very important)

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5.  How important is it to you to be in a business that is socially responsible? (10 = very important, 1 = not very important)

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6.  How strongly do you feel about using nutritional supplements for yourself and your family? (10 = very important, 1 = not very important)

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7.  How many hours  each week are you willing to work at your home based business?
  Select One 3-5 hours 6-10 hours 11-20 hours 20+ hours Whatever it takes

8.  How  much are you willing to invest to start your own business?     
$

Rainforest trip winners in Peru

9.  How much are you willing to invest on a monthly basis?   
$

10.  Do you have experience in any of the following areas? 
Select all that apply.

11. Do you love talking/working with people? A 10 = you enjoy it very much, 1 = you like to work alone.

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12.  Would you prefer to work at home full-time?

Yes

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Rainbow on Peruvian River

13.   If you are compatible with our business, would you like more information?

Yes

No

14.  What is your age bracket?  Select One 18-25 26-35 36-45 46-55 55+

15.  How did you find us?
Select One web search engine magazine/newspaper advertisement person newsletter

If you found us any way EXCEPT a web search engine, please list the person/magazine/advertising, etc.:

13.  Please enter your contact information:
Your name:               

Your email address:    

Your telephone (optional):