Start, Grow and Scale Your Business!

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Please complete this form to the best of your ability. This will help us determine how to best assist you.

Email *

How did you hear about us? *

1. Attended Workshop or Live w/ Samara Michelle

2. Facebook Ad

3. Christian Taylor Marketing Referral

4. Coach Nick Referral

5. Erin Burd Referral

6. Uzo Obiocha Referral

Other:

What is the business owners name? *

What is your email address? *

What is your best contact number? *

What is the name of your organization?

How would you best describe your business?
*

I have not officially started, but I am READY.

I have started a few things but not need help with direction.

I am operating my business but I am not getting results that I want.

I have been operation for less than 3 years and want to grow and expand.

I have been operating for more than 3 years and I am struggling in certain areas.

Other:

Describe your business structure.

I am a non profit organization with my 501(c)3.

I plan to be a non profit organization but I need my 501(c)3.

I am a small business and I already have an LLC or State Incorporation.

I intend to be a for profit small business.

I am operating a small business with customers and I am generating revenue BUT I want to learn about grants and government contracts.

I am not sure what type of business I want to start.

If you have already started your business, please state an estimate of your annual revenue. (Leave Blank if you have not started).

Check all that apply.

I have a business budget.

I can produce a financial statement from the previous year.

I have marketing plan.

Other:

Required

Please describe your purpose and planned products or services.

What are your top three goals?
*

What do you think would be most helpful in reaching these goals?
*

What are the roadblocks or challenges that are keeping you from taking your business to the next level?

ARE YOU READY to work with Samara Michelle NOW?

Yes, I am ready to take action to reach my goals.

Yes, I am ready but I would like more information about your services and pricing.

I have just started and I am still in the research phase and will continue following Samara Michelle Consulting.

Option 4

Other:

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