Platinum/Titanium Private Consulting

CONFIDENTIAL APPLICATION
PLEASE PRINT CLEARLY

Complete Contact Information/Profile:

Name_________________________________________

Spouse/Partner

Name

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Business Name_________________________________________________________________________________
Business Street Address__________________________________________________________________________
City _____________________ State ____________ Postal Code/Zip ____________ Country ____________
Optional Home Street Address____________________________________________________________________
City _____________________ State ____________ Postal Code/Zip ____________ Country ____________
Business

Phone_________________________________

Optional

Home

Phone_____________________________
Cell Phone: ___________________________________________ Fax______________________________________
Email_________________________________________________________________________________________
Years in Current Business ________ Spouse Is active in business: _______ Yes _______ No

Current Glazer-Kennedy Insiders Circle Member Status:

___Diamond/Diamond Luxury ___Gold/Gold Luxury ___Silver ___Non-Member

Web Site(s) Where People Can See Your Businesses

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What Are The Products Or Services You Provide?

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Briefly Describe Current Business Including Your Market And Scope

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1

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Briefly describe why you feel youre a good candidate for Richs Coaching
and Consulting Program: (attach additional sheet of information if necessary)

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CONFIDENTIAL DATA
Business Gross Volume
2012 - Projected
__Under $250,000.00
__$250,000.00 - $500,000.00
__Over $500,000.00 - $1-Million

__Over $1-Million - $3-Million

__Over $3-Million - $10-Million
__Over $10-Million

__Under $250,000.00
__$250,000.00 - $500,000.00
__Over $500,000.00 - $1-Million

__Over $1-Million - $3-Million

__Over $3-Million - $10-Million
__Over $10-Million

__Under $250,000.00
__$250,000.00 - $500,000.00
__Over $500,000.00 - $1-Million

__Over $1-Million - $3-Million

__Over $3-Million - $10-Million
__Over $10-Million

2011

2010

Rank Yourself in Direct Marketing Experience: (mark one)

______Very knowledgeable; serious student; very active in using strategies
______Very knowledgeable; serious student; but not very actively implementing
______Somewhat knowledgeable, actively implementing
______Somewhat knowledgeable but not very actively implementing
______A relative novice

How Many Marketing Strategies Or Systems Do You Have In Place That

Consistently Generate New Business For You? _______
How Many Marketing Strategies Or Systems Do You Have In Place That
Consistently Stimulate Repeat Business, Lock In Continuing Or Renewable
Income And/Or Stimulate Referrals? _______

Describe 3 Or 4 Specific Major Goals You Are Working Toward And Would
Like To Accomplish With The Help of Rich Sadlers Consulting and Coaching:
#1:
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#2:
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#3:
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#4:
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#5:
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Biggest Personal / Business Challenge (Rank EACH 1-10, 10 Big, 1 Teeny)
Clarity Of Goals & Objectives
`
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Turning an Ordinary Biz Into An Extraordinary Biz
_____
Skills Better Than Present Opportunity
_____
Time Management & Personal Productivity
_____
Employees
_____
Fighting To Shed/Transcend Limiting Beliefs
_____
Confidence &/or Strategies To Raise Prices/Fees
_____
Competition, Commoditization
_____
Finances (i.e., making but not keeping money)
_____
Leaping vs. Ladder-Climbing (Im still ladder climbing)
_____
Still Heavily Influenced, Restricted By Norms
_____
Other:
_____
Self-Assessment: Rank 1=Poor to 5=Darn Near Perfect
Advertising, Marketing & Sales Skills
Time Allocated To Marketing & Sales
Autonomy (Able To Do Business On Your Own Terms)
Discretion In Selecting Opportunities
Tough-Mindedness
Satisfaction with Income & Income Growth
Satisfaction with Wealth & Wealth Growth
Satisfaction with Time Allocation to Biz, To Personal
Agility: Anticipation of change, active embrace of change
Control of Business & Life
People You Associate With
People You Rely On
Year To Year Improvements, In Toto
Ability to Influence Others

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_____
_____
_____

Please rank each of the following marketing-oriented items according to the difficult or challenge they
currently represent to you; rank EACH ONE on a 1-5 scale, 1=Insignificant, to 5=Very Significant. ALSO,
number the ten most important items to you 1-10, 10=most important of all.
No.
Ranking
______ Advertising effectively
______ Generating sufficient QUANTITY of leads/clients
______ Generating satisfactory QUALITY of leads/clients

1
1
2

2
2
3

3
3
4

4
4
5

5
5

______ Converting leads to sales/clients

1
2
3
4
5
______ Controlling costs of advertising, lead generation, client acquisition 1
2
3
4
5
______ Client retention
1
2
3
4
5
______ Stimulating repeat business from clients
1
2
3
4
5
______ Stimulating referrals from clients
1
2
3
4
5
______ Clarifying my USP, Positioning, Marketing Messages
1
2
3
4
5
______ Creating compelling offers
1
2
3
4
5
______ Responding to marketplace changes, competition
1
2
3
4
5
______ Taking advantage of new opportunities, new technologies 1
2
3
4
5
Please rank each of the following business and financial-oriented items according to the difficulty or
challenge they currently represent to you; rank EACH ONE on a 1-5 scale, 1=Insignificant, to 5=Very
Significant. ALSO, number the ten most important items to you 1-10, 10=most important of all.
No.
Ranking
______ Finding time to implement new/improved marketing strategies
1
2
______ Getting employees and/or associates on board with my marketing approach
1
2
______ Clarifying and staying on track toward definite goals and objectives 1
2
______ Managing my time
1
2
______ Conquering procrastination
1
2
______ Hiring/training/managing employees
1
2
______ Monitoring and evaluating important data, statistics, information in my business
1
2
______ Setting, selling and commanding premium prices for my products/services
1
2
______ Maintaining satisfactory business profits
1
2
______ Extracting sufficient money from my business to wisely invest, build wealth
1
2
______ Taking a satisfactory amount of time off, away from my business 1
2
______ Having a long-term retirement/exit strategy
1
2

3
3
3
3
3

4
4
4
4
4

5
5
5
5
5

3
3

4
4

5
5

3
3
3

4
4
4

5
5
5

DO YOU REGULARLY OR FREGUENTLY USE:

Direct-mail
Voice Broadcast
Web Site
E-Mail
Print Media Advertising, Local
Radio/TV Advertising, Local
Publicity/News Releases, Local
Newsletter
Personal Networking
Tele-Marketing

____ YES ____NO

____ YES ____ NO
____ YES ____ NO
____ YES ____ NO
____ YES ____ NO
____ YES ____ NO
____ YES ____ NO
____ YES ____ NO
____ YES ____ NO
____ YES ____ NO

Other (please specify): _____________________________________________________________________

Describe 3 Major Sources of Stress, Frustration or Unhappiness that

Interfere with Your Productivity and Rob You of Peace of Mind (expand on
other side if needed)
#1:
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#2:
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#3:
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YOUR SCHEDULE

Number of hours you work, average week

______
Number of hours youd prefer to work, average week
______
% of work-time you rank as productive
______
No. of hours per week you work on vs. in your business
______
No. of weeks of vacation taken:
2009:______
______ ______
No. of weeks of vacation youd prefer taking:
______

2010:______

2011:

READINESS ASSESSMENT
RANK YOURSELF IN ONLINE AND OFFLINE MARKETING KNOWLEDGE: (Mark one)
____ Very knowledgeable; serious student; very active in using strategies
____ Very knowledgeable; serious student; but not very actively implementing
____ Somewhat knowledgeable; actively implementing
____ Somewhat knowledgeable but not very actively implementing
____ A relative novice
What Do You Find Most Difficult To Swallow, Agree with, Embrace, Use or Implement from
what You Know of Rich Sadler, Business Growth Advisors and Glazer-Kennedy Insiders
Circles Direct Response Style Marketing?
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When you decide to do advertising and marketing describe the steps you typically take:
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Any additional comments:
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Once your business is growing exponentially and profits have increased substantially would
you be willing to draft a glowing testimonial for Rich Sadler and Business Growth Advisors
and allow us to share it widely? Yes: ____ Not sure: ____
What would be the top 3 factors of improvement that would make you keenly enthusiastic to
write such a testimonial letter? (expand on other side if needed)

#1:
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#2:
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#3: __________________________________________________________________________