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First Name *

Last Name *

Email Address *

Phone Number (000-000-0000) *

Consultant's name who asked you to watch a video. (First and Last name, please.) *

What impressed you or surprised you the most about the information you heard in the video? *

After watching, which one of these categories do you most relate to? *

A. SMART SHOPPER: 50% discount on your products, your own best customer, opportunity to expand in the future if you desired to.

B. EXTRA CASH/PLAN B: Flexible hours, freedom to earn extra cash, fun.

C. NEW OPPORTUNITY: Growth at my own pace, excited to be my own boss, promote myself when I'm ready, working from home, unlimited earning potential, Career Car Program, security, flexibility, online education and personal mentorship.

Which of these things are important to you? *

Extra money

Being able to balance life with faith 1st, family 2nd, and career 3rd

Prizes, awards, and recognition

Being your own boss/working from home

Flexibility, more personal and family time

Improving yourself, grow in self-esteem and confidence

Tax Deductions

Required

If you were to ever start a Mary Kay Business, which would you pick? (See image for more information)

I would want the Starter Kit with an E-Start with the Sample Pack Add-On for $175

I would want the Starter Kit with an E-Start for $130

I would want to do an E-Start with a Sample Pack Add-On for $75

I would want to do an E-Start only for $30 (No Sample Pack Add On)

Clear selection

Now YOU (and your consultant) will be entered in the drawing for a FREE GIFT!

Thanks again for your time! - Diane Lundgren, Pink Cadillac Million Dollar Sales Director

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