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Application Form

Please complete the following questions. Your answers are held in the strictest confidence.

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Name*
First Last
Email*
Enter Email Confirm Email

Please select which best describes your current situation:*
- I haven't started my digital business yet
- I have a digital business generating revenue

OK thanks, which best describes your digital business idea? Tick all that apply.*
- I want to sell digital (online) courses and programs
- I want to sell coaching, consulting, or mentoring online
- I want to sell physical products and have an ecommerce store
- I want to host live (in-person) events

OK great, which type of digital business are you in? Tick all that apply.*
- I sell digital (online) courses and programs
- I sell coaching, consulting or mentoring
- I have an ecommerce store selling physical products
- I run live events (in-person)

Let me know your monthly revenue (or income) bracket.*
All answers are protected and covered by our privacy policy.
- 0 - 10,000
- 10,001 - 25,000
- 25,001 - 100,000
- 100,001 - 250,000
- 250,001 - 500,000
- 500,001 - 1,000,000
- 1,000,000 +

In your current digital business, let me know your monthly revenue bracket.*
All answers are protected and covered by our privacy policy.
- 0 - 10,000
- 10,001 - 25,000
- 25,001 - 100,000
- 100,001 - 250,000
- 250,001 - 500,000
- 500,001 - 1,000,000
- 1,000,000 +

In your own words, please describe what you want to achieve? For example, what would need to happen in the next year for you to look back and know you'd succeeded?*
What do you believe is the main obstacle or challenge you're facing right now in terms of achieving your goal?*

Answering truthfully, why don't you believe you've achieved your goal yet? What do you think is the real reason?*

Lastly, why are you reaching out to Dr Nic? How would you like him to help you?*

To submit your application, please select one final option and then click to send your application.*
- I am just collecting information. I'm not ready to invest in my business.
- I want to get help, and am ready to start within the next 3 months
- I am ready to invest in my business and get the help I need now

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IMPORTANT: Earnings and Legal Disclaimers
Earnings and income representations made by Provaleo are aspirational statements of earnings potential. The success of Provaleo, Dr Nic Lucas, clients and other examples are exceptional, non-typical results and are not a guarantee that you or others will achieve the same results. Individual results will always vary and your results depend entirely on your individual capacity, work ethic, business skills and experience, level of motivation, and diligence in applying any Provaleo programs, the economy, the normal and unforeseen risks of doing business, and other factors. Provaleo is not responsible for your actions. You are solely responsible for your own decisions and actions and the evaluation and use of our products and services should be based on your own due diligence. You agree that Provaleo and Dr Nic Lucas are not liable to you in any way for your results when using our products or services. See our Terms of Use, Earnings Disclaimer & Privacy Policy for more information.

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