Accountability Client Intake Form
Welcome and thank you so much for joining me. I'm humbled and excited you've chosen me to support you. I'm looking forward to working with you and watching you accomplish all of your goals.

Please fill out the form below to help me get more acquainted with you and your needs.

Here's a little bit about me: I'm a wife and mother who loves tennis, sewing, working out and finding new "healthy" recipes. I've tried and failed at going Vegan more times than I care to share and I love a good comedy. I'm pretty passionate about entrepreneurship and advocate for it whenever I can.

I used to do freelance marketing and now co-own a trucking company with my husband. This business of consulting other entrepreneurs and accountability coaching are a natural progression because I want to see you win! I hope you're ready to put in some work because I'm here for it.

If you haven't already, you can visit my YouTube Channel to see more of me: @AmiraBellaShante

After receiving your completed inquiry, I'll be in touch with next steps.
Thank you, Shante
Sign in to Google to save your progress. Learn more
Email *
Name *
Nickname (if applicable)
Cell Phone (Optional)
Address (for gifts that I send, but optional)
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy