Mike Wayne

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First Name

Last Name

Phone *

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Company Name *

Website *

So where did you find me? *

What best describes your investment capacity right now? *

I’m ready for private consulting and/or solutions ($10K+)

I’m open to group or systems implementation ($5K+)

I’m interested in strategy sessions or starter offers ($500–$2K)

I’m not ready to invest financially right now

If you selected a paid option above, what’s your approximate annual budget for business growth? *

Have you hired a coach/consultant before?

Yes

No

If yes, what was your experience like?

What’s the #1 challenge you're facing right now in your business?

What have you already tried to fix this?

What’s blocking you from getting more clients or more sales?

If you could start over, what would you stop doing or change?

Where do you want to be 6 months from now after working with me?

How are you currently getting most of your leads? (Other)

Which platform are you most active on?

Which platform are you most active on? (Other)

Do you have an Email list?

Yes — Active

Yes — Inactive

No

Why did you decide to apply to work with me?

How long have you been following my work?

On a scale of 1–5, how committed are you to investing your time, money & energy into your business growth?

5 – All In → I’m fully committed and ready to take action now.

4 – Serious → I’m committed, just finalizing my next steps or timing.

3 – Warming Up → I’m interested, but I still have questions or concerns.

2 – Exploring → I’m not ready to commit, but I’m learning and considering options.

1 – Just Curious → I’m browsing or gathering ideas for the future.

Final Note Before You Submit

My programs, systems, and strategies are designed to support committed business owners — not replace their involvement.

I can give you clarity, structure, and execution support, but I can’t care about your business more than you do.

If you’re looking for a shortcut, a crutch, or a way to hand off responsibility, this isn’t the right fit.

The clients who get the best results are the ones who show up, stay engaged, and treat their business like a priority — not a side project.

If that sounds like you, I look forward to helping you build something that actually works :)

— Mike

Mike Wayne

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