Your First & Last Name

Your Email

Your Best Phone Number

Your Business Name

Do you have a website? If yes, please share the link and what is the overall objective of your website?

Please list your social media links (Facebook Fan Page, Instagram, LinkedIn, YouTube, Twitter, etc.)

What is your primary Industry Category? —Please choose an option—AdvertisingAlarm/Security SystemsAntiquesAppraisersArchitectAttorneyAuto Body Shop/RepairBalloon ArtistBanker (Commercial)Banker (Consumer)Bookkeeping ServiceBusiness Machines/CopiersArtistCatererCellular SalesNot For Profit OrganisationChiropractorCleaning ServiceComputer Sales/Service/ConsultantCosmetic SalesCPA / AccountantDentistDirect MailDJ / EntertainerElectricianEvent PlannerEventsFinancial PlannerFlooring / CarpetsFloristFood/Coffee ServiceFuneral DirectorGeneral ContractorGift BasketsGraphic DesignerHairdresserHandyman/HandywomanHome/Building InspectionsHuman Resources ServicesHVACInsurance (Consumer, Car, Health, Life, etc.)Insurance (Commercial)Interior DesignerLandscaperLimousine ServiceLuggage / Bags SalesManagement ConsultantManufacturingMarketingMassage TherapistMortgage Lender/BrokerNutritional ProductsOffice FurnitureOffice SpaceOffice SuppliesOptometristOrganiserP&C InsurancePainterPayroll ServicesPersonal TrainerPest ControlPhotographerPlumber / Gas FitterPrinterPromotional ProductsProperty ManagementPublic RelationsReal Estate Agent (Commercial)Real Estate Agent (Residential)Remodeler (Home Improvement)RemovalistSign CompanySpaTelephone SystemsTemp ServiceTravel AgentVeterinarianVideographerWeight Loss ConsultantOTHER

Please describe your business and services you offer

What are your Top Business Challenges

What are your Top Business Wins

What do you expect to achieve within the next 4 weeks?

Simplify my existing businessAttract more and better qualified leadsConvert more leads into buying customersIncrease the average transaction value of salesGenerate more repeat salesIncrease the amount of time customers stay with usReduce costs and expensesHire better employees / Keep our good employeesIncrease profitsEnable me to get away from the business more

What is the most profitable aspect of your business?

What is your latest annual revenue? $0 – $250,000$250,001 – $500,000$500,001 – $1,000,000$1,000,001 – $5,000,000$5,000,001 – $10,000,000> $10,000,000

What is your Gross Profit? (Annual Revenue minus the cost of goods sold)

What is your Net Profit? (revenue after subtracting all operating, interest, and tax expenses, in addition to deducting your cost of goods sold)

Which answer describes you best: I'm good at finding reasons why something might not workI'm good at finding reasons why something might work, but don't always take the necessary action to get the desired resultWhen I see something that has a good chance of working, I pull out all the stops and move quickly and confidently to attain the desired result

The Mega Month Mastermind investment is AU$250 plus 10% GST. Please note that on acceptance of your application, which will take place during the phone call you will schedule with us, we will ask you for your credit card details. This will then secure your spot in the Mega Month Mastermind. We will be in touch with more details to help you prepare for Day 1. If you are not successful, we will politely let you know, so you can be free to pursue other opportunities. We will not ask you for any credit card and payment details. I understand should I be accepted into the Mega Month mastermind, I will be charged for $800 plus GST through a secure payment system (e.g. Stripe) Yes. I agree to being charged a one-time payment of AU$250 plus 10% GST upon my application being accepted.