Please Fill Out Questionnaire

Complete This Online Questionnaire


Your Name:
Your Phone Number:
Your Email:


The Benefit I want from My Income Partners is (choose one): Category 1 – Supplemental Income / Preferred Customer and save 30-40% Category 2 – Part-time Business / 5-15 hours a week with a goal of $500– $5000 a month Category 3 – Serious Referral Business / 20 plus hours a week with a goal of $5000 - $20,000 a month, and looking for that financial freedom


The Reason I want to start a Home-Based Business is:



The Statement which best describes my current situation is (choose one): My current income is enough to cover my monthly bills. My current income does not cover my monthly bills.


When I’ve reached my ultimate long-term goal in my business, I would like to be earning $ per year.


I have decided to commit hours each week to work my business.


By working my business this many hours weekly, I think it is reasonable to reach my ultimate long-term income goal in the following timeframe (example: 6 months, 1 year, 2 years etc.)


Within 6 months I would like to reach a monthly income level of $


How many product points a month do you need to order to receive a commission check as a preferred customer (choose one): 110 35 88 200


What statement best describes your commission percentage off your primary and secondary referrals (choose one): I make up to 20% off my primary referrals and 7% off my secondary referrals through seven referral generations. I make up to 25% off my primary referrals and 10% off my secondary referrals through unlimited referral generations.


Are you ready to continue to the next step in the screening process? Yes No