Name-First and Last  * Email  * CityStateZip  * Valid Phone #  * How do you prefer to be contacted? PhoneEmailUS-MailFax What interests you the most about a business with Mia Bella's Candles? Be specific wright as much as you want Referred by? Are you seriously interested in a home business? Yes of course!MaybeNo!I have no idea What is your interest level based on current knowledge? I am a 10 let's get started!I am a 7 or higher more infoI am a 5I have no idea Are you interested in learning how to create multiple income streams that grow with the service of others? Yesof course!MaybeNoI have no idea Are you willing to go through the fact finding proccess to get your questions answered? By phone or email Yes No Have you ever owned a business before? YesNo Are you willing to commit to a system and be coached and trained by those already successful? YesNo What is your primary reason for wanting to work from home? Write as much as you want What is most important to you in a home business? Ability to work from home using the internet.Well established debt free company.To be coachedtrained and showed exactly what to do.Easy for anyone to do regardless of computor knowledge.Unlimited potentialAll of the aboveI have no idea Do you have previous Network Marketing experience? No what is it?Yes I have been involved beforeNever but curiousIs this a scam? Are you currently involved with a network marketing company? NoYes but I am interested in changing companiesYes but I want to remain with my currect company too.I have no idea Current occupation or company affilliation How much would you like to earn in this business per month? Have you or do you want to work with leads? Yes I have no friends leftMaybe lets talk about itIf my friends say noI already use leadsWhatever it takes How much time would you be willing to committ each week? 5-1010-1515-20Full time What is your monthly income goal? 500-10001000-50005000-1000010000 This business is based on the fact that millions of people are logging onto the internet each and every day. A large percentage of them would like to have their own business. If you were convinced beyond a shadow of a doubt that the products and the financial potential of this business were honestly the opportunity of a lifetime how much would you be willing to invest in your future? $200$300$500$1000 Thanks and congratulations on taking the time to invest a few minutes in your future. If we mutualy agree that this is for you you will be mentored and trained by the best in the industry for free. People that know how to get results! By taking these few moments I promise you that you will have the ability to make a profound difference in the lives of many! Comments: Security code:   * Do not enter anything in this field:

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