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silverstone consulting

empowering excellence in business and in life^™

The Business Owners

Mastermind Group

Confidential Application Form

(Please complete as much as you can)

Name
Position
Company
Address
City	State Zip
Phone
Email
Website

In which industry are you engaged?

On a scale of 1-10, indicate your personal level of satisfaction or confidence with the following business functions:
Sales/Marketing
Administration/Operations
Production/Distribution
Product/Service Development
Financial/Money Management
Other (please specify)

Please provide a brief description of your business challenges

What sales volume are you projecting for the coming year?

Is there anything else you would like us to know about you, your company, your product or yourself, that will assist us in aligning you with a Mastermind group.