BBS Application Form - Dreams For Real

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Your Business Blind Spots Coaching Application

Please complete the application below and you will then be directed to a scheduler to make an appointment to speak with me, Dr. Sam Gerstein, so I can learn how I can better help you uncover your Business Blind Spots and take your business to the next level.

Name of your business *

Website *

Did you watch the informational video on the previous page? *

Yes
No, not yet

Please tell me a little bit about your business: (Please include your target market and the value proposition you offer them) *

What is your CURRENT monthly revenue? *

Startup (pre-revenue)
Less than $10k per month
Between $10k and $50k per month
Between $50k and $100k per month
Greater than $100k per month

How long have you been stuck at that revenue? *

Less than 6 months
Between 6 months and 1 year
Between 1 and 2 years
Between 2 to 5 years
Greater than 5 years

How long have you been in business for? * *

just launching now
less than 1 year
Between 1 and 5 years
Greater than 5 years

What is your TARGET ANNUAL revenue in the next 12 months? *

$100k - $200k
$200k - $300k
$300k - $500k
$500k - $750k
$750k - $1M
> $1M

What do you believe is the single biggest hurdle right NOW that is keeping you stuck at this revenue? *

What steps have you taken to get past that hurdle? *

How much have you spent in the past 12 months trying to push you past this ceiling? (Eg: hiring team members, paid marketing, consultation, R & D, content creation, etc...) *

< $2k
$2k - $10k
$10k - $25k
$25k - $50k
$50k - $100k
> $100k

What is your current budget for the NEXT 12 months to push you past this ceiling? (Eg: hiring team members, paid marketing, consultation, R & D, content creation, etc...) *

< $2k
$2k - $10k
$10k - $25k
$25k - $50k
$50k - $100k
> $100k

Why is NOW the right time for you to get help with your business? *

Your Name *

First

Last

Your Best Email address *

Please enter your email, so we can follow up with you.

Name

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