In hand Media Inc.

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First Name: *

Last Name: *

Address: *

City: *

State/Province: *

Country: *

ZIP/Postal Code: *

Phone: *
(include country code if outside the U.S. or Canada)

Cellular Phone:
(include country code if outside the U.S. or Canada)

Email Address: *

Best Time to Reach:

Area of interest: *

Are you looking to do this hands-on or as an investor?

Hands-on Investor

I have owned my own franchise before

Yes No

I have owned my own business before

Yes No

I have managed people before

Yes No

I have direct sales experience

Yes No

Is Your Net Worth Greater Than $150,000 (assets less liabilities = net worth)?

Yes No

Do You Have Liquid Assets Greater Than $75,000?

Yes No

Why are you interested in In Hands Media?

How did you hear about In Hands Media franchise opportunities? *

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