Please complete all sections

I have problems with:

Cancelled Appointments
Prospecting
Wasting time with unqualified prospects
Losing control of the sales cycle
Getting people to make and keep commitments
Feeling pressure in selling situations
Getting: "I'll think it over..."
Difficulties in actually closing the sale.
Problems getting past the secretary
Making proposals and not getting the business
Not making all the money I feel I should
Having a hard time picking up the phone and making calls
Procrastinating

Do you have a budget set up to solve this problem?

Yes No

Are you the person who makes these decisions?

Yes No

Are you committed to finding a solution to this problem?

Yes No

Are you committed to working in collaboration?

Yes No

Are you willing to take action and learn from my results.

Yes No

Name

Email Address

Title

Company

Street Address

City

State/Province

Postal Code

Day Phone

Best Time to Call

How do you want to be coached? Please check one or more of the boxes at right.

Phone: One-to-one
Phone: In a Group
E-mail
FAX
In Person: One-to-one
In Person: Group

Please check One:

[Committed now]
[In 1 month]
[In 3 months]
[In 6 months]