First Name*
Last Name*
Phone*
Email*
Are you familiar with America's #1 millionaire maker - Robert G. Allen?
Select
Yes
No
Do you have a Millionaire Mindset
"To Fly As Fast As Thought, To Be Anywhere There Is, You Must First Begin By Knowing That You Have Already Arrived." By Richard Bach
Do you believe you have the potential to make more money if you knew how? (Given the right mentor, team, systems and tools.)
Select
No
Yes
Scenario: If you came across a Real Estate deal that would put $25,000 dollars in your pocket in 60 days and all you had to do was come up with $5,000 down how would you do it?
Select
Find a partner to put up the money.
Borrow from friends/family.
Borrow it from a credit card.
Borrow from savings/checking.
Use a hard money lender.
I'm not sure.
Borrow against home.
Sell my assets.
Your Current Financial Situation
A good doctor always diagnosis his patient before he prescribes a remedy. Likewise, before we can even think about helping you, we need to know where you're at financially. Take a few moments to explain your current financial situation below.
What is your current employment status?
Select
Employed
Unemployed
Self-Employed
My spouse works
How long could you survive on savings if you had no income?
Select
Less than 1 month
2 months
3 months
4 months
5 months
6 - 18 months
Forever - residual income.
Do you own or rent your current place of residence?
Select
I own my Residence
I am Renting
Have you ever used a credit card before?
Select
Yes
No
I used it for...
Select
starting a business
investing purposes
education
impulse buying
everyday necessities
all the above
Don't use credit cards
Please
explain your current financial situation.
Your Financial Goals
"Everyone thinks that the principal thing to the tree is the fruit, but in point of fact the principal thing to it is the seed." Friedrich Wilhelm Nietzsche.
How much do you want your bank account to grow in the next 90 days?
Select
$5,000
$10,000
$25,000
$50,000 or More
Which vehicle will help you achieve this?
Select
Real Estate
Stock Market
Business and Marketing
Internet
Do you believe you can achieve this goal with my help?
Select
Yes
No
How Committed Are You
"Take the first step in faith. You don't have to see the whole staircase. Just take the first step." Martin Luther King Jr.
Do you understand that in order for your income to change you must change? (i.e. you attitudes, perceptions and habits)
Select
Yes
No
Are you willing to invest 5-10 hours of your time each week to pursue your financial goals?
Select
Yes
No
Would you give at least 10% back? (i.e. to a church, charity, cause or community organization)
Select
Yes, I would give back at least 10%
No, I will not give back at least 10%
Enlightened Millionaire Success Stories
"Each one, reach one. Each one, teach one. Until all are taught." By Mark Victor Hansen
Yes, Robert
Allen has my permission to use my success story. (i.e. T.V. Radio, Newspaper, Internet)
Are you willing to invest in yourself and your education?
Yes
No
Why do you think you should you be considered for the One Minute Millionaire Challenge?
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