First Name*

Last Name*

Address*

Street Address City State ZIP Code

Home Phone*

Cell Phone*

Email*

Age*

Occupation*

How many hours a week can you devote to learn how to make money in real estate?*

What is your goal for learning real estate?*

Do you have a real estate license?*

Please list any real estate classes, courses or seminars you have attended*

Have you implemented any ideas or techniques that you learned?*

I learn new skills:*

My personality is:*

I view new and uncomfortable tasks:*

I normally:*

Household Income*

Do you own any real estate? If so, what type(s)*

How much money could you invest per month to grow your real estate business?*

How much capital could you raise for a good deal that you could make money with?*

How much would be your cash?*

How much would be borrowed?*

Please list your two biggest role models:*

Name 3 things you would buy if you won the lottery:*

What would you do with your time if you did not have to work 40 hours a week?*

What are your hobbies and interests?*

Any thing else you would like to tell us about yourself:

Other comments

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