*Today's Date:

*Name:

*Address:

*City:

*State:

*Zip Code:

Phone:

*Email Address:

Consultant's Name - this will be the person who referred you to this site.

Age
18-24
25-30
31-40
41-50
51-60
60+

Marital Status:

Married
Divorced
Widowed
Single

Occupation:

*What Do You Like Best About Your Current Job?

*What Do You Like Least About Your Current Job?

Family Information (# of children, etc.)

*These are some of the reasons women have chosen to join Mary Kay. Which apply to you?

Excellent INCOME for part-time work and ADVANCEMENT OPPORTUNITIES
Improve SELF-CONFIDENCE and gain RECOGNITION for achieving goals
Earn a FREE CAR
Set my own FLEXIBLE SCHEDULE
Owning my OWN BUSINESS and enjoying TAX BENEFITS
Company philosophy: FAITH first, FAMILY second, and CAREER third
Gain new FRIENDS
Unlimited EARNING POTENTIAL
ASSISTING OTHERS in looking their best and discovering their full potential

*From what you just heard/read, what appealed to you most about the Mary Kay Opportunity?

*If I could show you how to make $150-$300 in 6-8 hours a week, would you listen?   

Yes
No

*How would you spend the extra money?

*How Interested Are You in Becoming a Mary Kay Consultant?

A - ABSOLUTELY, Where do I sign?
B - Buy me a coke - I would like to hear more!
C - I would like to see more about Mary Kay.
D - Definitely not, however, I will be a great customer for my consultant and send her tons of referrals because I know how great she is and how great Mary Kay is!

*Have you received your $13 pinked card?

Yes
No