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* First Name

* Last Name

* Email Address

* What City do you live in?

What's your website link? (If you have one)

* Which Service Are You Interesed In? * Which Service Are You Interesed In? Lead Generation System Sales Page Design & Strategy Tripwire Funnel Design & Strategy Custom Website & Strategy Website & Sales Funnel Design & Strategy The Uplift Website VIP Day / 1 day work Brainstorm Session Other : Please specify

* Please specify what you need.

* What do you do? What is your business about? Who are your clients?

* How long have you been in your current business? * How long have you been in your current business? Less than a year Between 1-2 years Between 2-3 years Over 3 years

* How would your business change if you had this [your chosen service with me] implemented? * Tell me 3 things...

* Do You have a realistic budget to scale your business with a strategically crafted website / sales funnel? If we decide to work together. * Do You have a realistic budget to scale your business with a strategically crafted website / sales funnel? If we decide to work together. Yes Not sure

Facebook Profile Link (In case I need to contact you asap)

* I consent my email address to be added to Veronika's email list. * I consent my email address to be added to Veronika's email list. Yes I am cool with it and can unsubscribe at any time.

* Please acknowledge that my - Veronika's - design and strategy rates starts from 500$, * Please acknowledge that my - Veronika's - design and strategy rates starts from 500$, Yes, I understand!

* Last question: Team Captain America or Iron Man? * Last question: Team Captain America or Iron Man? Captain Amercia All the way baby! Iron Man is the one that rocks!