My Name:

My Consultant's Name:

Home Number:

Cell Number:

Best Time to Reach You:

What would you like to have more of in your life right now?

(Hold Down CTRL to select more than one)

Choose Fun & Girlfriend Time Flexibility & Freedom Money & Perks Greater Hope & a Positive Plan for Your Future Stability & Security A Feeling of Significance; That you are making a difference

If you were looking for a job, what 3 things about that company would be most important for you to know?

#1

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Studies show that by the year 2010, 1 out of every 3 American homes will have a home based business. Yet there are 5

reasons why women do not start a business for themselves. Please pick the one that would most apply to you:

Choose Too Busy Not Self Motivated Enough Start Up Costs Procrastination Don't Need Any Extra Income

Have you recently thought about getting a part-time or supplemental job?  

Choose Yes No

If yes, please pick the amount of money you would want to make monthly in a part time position?

Choose 250 500 1000 1000 Plus

Have you ever researched owning your own home based business and being your own boss?

Choose Yes No

If yes, which one?

If you were to become an independent contractor with Mary Kay, what about that would you enjoy the most?

What 3 qualities do you possess that would contribute to the Success of having your own business?

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#2

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