Please answer all questions honestly so we can prepare a useful game plan for you. This is not a test! You cannot fail.


First Name :
Last Name :
Age :
Address :
City :
State :
Zip Code :
Apartment/Unit # :
Home Phone : (format 123-555-5555)
Fax :
Cell Phone : (format 123-555-5555)
Email Address :
Marital Status :
Spouse's Name :
Number of Children :
Type of Work :
If Self-Employed, What Business? :
Yearly Income :
Spouse's Income :
Education : Grade School
High School
Specific Skills :
Do you have a real estate license? :
Have you ever? :
Time each day you can set aside learning how to make more money :
What is your 3-year income goal? :
Can you follow instructions even if you have previously never done the task you will be assigned? :
Are you willing to pursue some tasks that may not be in your comfort zone? :
How would you consider yourself? :
(Describe): :
Do you own your residence? :
Do you own other property? :
If yes, what type? :
How is your credit? :
If you found a good deal that needed capital and you were convinced you could profit, how much could you raise? :
How much of the above funding would be your money? $ :
How much of the above funding would be borrowed money? $ :
Do you normally: :
Have you talked with your spouse about doing Residential/Commercial Real Estate? :
Will you be working with his/her cooperation or in spite of his/her objection? :
Please list the real estate courses you have purchased or attended to date: :
Have you actually tried any of the techniques you learned in any of these courses? :
Please explain why or why not: :
Who are your two biggest role models? :
When you start making a seven figure income, what will you do differently? :
Do you travel? :
Where would you go if money wasn't an issue? :
Who would you take with you? :
Name the first 3 things you would buy if you won the lottery: :
What would you do with your time every day if you had all the income you needed and didn't have to work? :
What activities or hobbies do you enjoy the most? :
Is there anything else your coach needs to know to provide you with the best possible assistance? :
Best day/time for your coach to contact you regarding your profile :
Comments :
Certification : I certify that my answers are true and complete to the best of my knowledge.

Complete Below If You're A Military Veteran

Please Select Your Branch of Service :

When did you start serving? :
When did you stop serving? :
Did you serve in combat zone? :
If so, where? :
DD214 :
Honorable Dischange :
  Indicates Required Field