SmartMomsOnly Request Information

Take a minute to fill out the form below and one of our SmartMoms will contact you personally. She’ll give you all the details and information you need to decide if our opportunity is right for you.

As you fill out the form, please feel comfortable knowing that the person who’ll be contacting you has your best interests at heart … and is a SmartMom and a caring mom, just like you. Your information will be kept in strict confidence and will not be shared with any group or used for any other purpose.

IMPORTANT: Please help us learn how you found out about SmartMomsOnly™.com.
	E-zine Ad Newsletter Article Radio Show TV Home School Convention HomeWorkingMom.com Referred by another SmartMom Name of SmartMom Flyer (Enter code found at bottom of flyer)
1)	Why are you interested in a home based business?
2)	What amount of monthly income are you interested in earning? $100 - $500 $501 - $1000 $1001 - $5000 $5001 - $10,000 $10,001 - $25,000 $25,000+
3)	What amount of money would you be willing to invest on a monthly basis if we can show you how to earn the monthly income you desire in 1-3 years? $0 - $50 $51 - $100 $101 - $250 $251 - $500 $500
4)	How much time are you willing to invest on a weekly basis 0-2 hours 2-5 hours 5-10 hours 10-20 hours 20-40 hours 40 + hours
5)	Have you ever been involved in your own business before? No Yes
6)	If so, what was your experience?
7)	Why are you someone we should invest our time to train?
8)	If you qualify for our business, and like what you see and hear, when would you be interested in getting started?
9)	The best time to reach you is (please include the time zone):
10)	Is there anything you'd like us to know?
*11)	First Name
*12)	Last Name
13)	Mailing Address
14)	City
15)	State
16)	Zip
*17)	Email
*18)	Phone (with area code)
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