This Questionnaire is to define whether someone is a good prospects for this business.

(Please Print Clearly)
Date: __________________________________________
Name: _________________________________________
City: __________________________________________
Phone: ________________________________________
Best Time to Call: ________________________________
Email: _________________________________________

Your current occupation? __________________________
How many years at current job? _____________________

1. Would your income stop if you lost or quit your job? Yes ❑ No ❑
2. People who have been working a long time at your company, are they making a lot more money than you are? Yes ❑ No ❑
3. Do you plan on retiring comfortably on Social Security? Yes ❑ No ❑
4. Have you ever dreamed of being wealthy? Yes ❑ No ❑
5. Have you given up on that dream? Yes ❑ No ❑
6. Have you ever built a successful home-based business? Yes ❑ No ❑
7. Are you willing to learn from successful people? Yes ❑ No ❑
8. Do you know others who are financially frustrated? Yes ❑ No ❑
9. If you won $5M dollars on the Lottery tomorrow, list the first 5 things you would do or buy: __________________________________________________
________________________________________________________

Reality Check: Most people today can’t write a check for 1% of what they made over the past 10 years. Someone making $50k per year, made $500k over 10 years and Nothing changes if nothing changes.

We’re looking for people who are tired of just getting by and breaking even.

We are creating a new social media platform that will create a massive shift, in our digitally connected world, by sharing a significant portion of our revenues with our members. Our monetization model is extremely unique and the potential is life changing, as we’re about to totally change the game, for millions of good people!

Open the door to the right opportunity once, and you can change your life, forever…! Never let a job, keep you from your Dreams!