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High Impact Consultation
Qualification Form

[headline style="1" font_size="50" font_font="Gill%20Sans" font_spacing="-1" align="center" headline_tag="h2"]High Impact Consultation<br />
Qualification Form[/headline]

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[custom_html]

Please answer all questions honestly and completely, so you can receive the highest of level service during your reserved time. Once this application is completed, you’ll gain instant access to my schedule where you’ll choose a date and time that works best for you and your team.

In your honest opinion… What is the #1 Challenge With Growing Your Business? *

Give me a brief thumbnail sketch of your business, the products/services you offer, as well as the average prices.*

Current Monthly Revenue (Sales)?*

Your Ideal Monthly Revenue (Sales)?*

What is you're Current Monthly Marketing/Ad Budget:*

What is the Size of Your Email List:*

During The Next 12 Months, What Would You Like To Be Personally Earning?

What Would Achieving That Level of Income Do For You?

Are You The Decision Maker For Your Business? *

Yes

If You Selected "No" To The Previous Question, Please List Who Is The Decision Maker, Along With Their Number:

If you have a website, please share the URL below:

How did you find us? *

Facebook

Instagram

Google

Youtube

Our Website

Other

Full Name

Phone

Email*

Marketing by

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          Please answer all questions honestly and completely, so you can receive the highest of level service during your reserved time. Once this application is completed, you'll gain instant access to my schedule where you'll choose a date and time that works best for you and your team.<br />
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        In your honest opinion... What is the #1 Challenge With Growing Your Business? *<br />
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        Give me a brief thumbnail sketch of your business, the products/services you offer, as well as the average prices.*<br />
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        Current Monthly Revenue (Sales)?*<br />
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        Your Ideal Monthly Revenue (Sales)?*<br />
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        During The Next 12 Months, What Would You Like To Be Personally Earning?<br />
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        What Would Achieving That Level of Income Do For You?<br />
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            If you have a website, please share the URL below:<br />
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    var regexStr = "field\[(\d+)\]";<br />
    var results = new RegExp(regexStr).exec(allInputs[i].name);<br />
    if (results != undefined) {<br />
      allInputs[i].dataset.name = window.cfields[results[1]];<br />
    } else {<br />
      allInputs[i].dataset.name = allInputs[i].name;<br />
    }<br />
    var fieldVal = getUrlParam(allInputs[i].dataset.name);</p>
<p>    if (fieldVal) {<br />
      if (allInputs[i].type == "radio" || allInputs[i].type == "checkbox") {<br />
        if (allInputs[i].value == fieldVal) {<br />
          allInputs[i].checked = true;<br />
        }<br />
      } else {<br />
        allInputs[i].value = fieldVal;<br />
      }<br />
    }<br />
  }</p>
<p>  var remove_tooltips = function() {<br />
    for (var i = 0; i < tooltips.length; i++) {<br />
      tooltips[i].tip.parentNode.removeChild(tooltips[i].tip);<br />
    }<br />
      tooltips = [];<br />
  };<br />
  var remove_tooltip = function(elem) {<br />
    for (var i = 0; i < tooltips.length; i++) {<br />
      if (tooltips[i].elem === elem) {<br />
        tooltips[i].tip.parentNode.removeChild(tooltips[i].tip);<br />
        tooltips.splice(i, 1);<br />
        return;<br />
      }<br />
    }<br />
  };<br />
  var create_tooltip = function(elem, text) {<br />
    var tooltip = document.createElement('div'), arrow = document.createElement('div'), inner = document.createElement('div'), new_tooltip = {};<br />
    if (elem.type != 'radio' && elem.type != 'checkbox') {<br />
      tooltip.className = '_error';<br />
      arrow.className = '_error-arrow';<br />
      inner.className = '_error-inner';<br />
      inner.innerHTML = text;<br />
      tooltip.appendChild(arrow);<br />
      tooltip.appendChild(inner);<br />
      elem.parentNode.appendChild(tooltip);<br />
    } else {<br />
      tooltip.className = '_error-inner _no_arrow';<br />
      tooltip.innerHTML = text;<br />
      elem.parentNode.insertBefore(tooltip, elem);<br />
      new_tooltip.no_arrow = true;<br />
    }<br />
    new_tooltip.tip = tooltip;<br />
    new_tooltip.elem = elem;<br />
    tooltips.push(new_tooltip);<br />
    return new_tooltip;<br />
  };<br />
  var resize_tooltip = function(tooltip) {<br />
    var rect = tooltip.elem.getBoundingClientRect();<br />
    var doc = document.documentElement, scrollPosition = rect.top - ((window.pageYOffset || doc.scrollTop)  - (doc.clientTop || 0));<br />
    if (scrollPosition < 40) {<br />
      tooltip.tip.className = tooltip.tip.className.replace(/ ?(_above|_below) ?/g, '') + ' _below';<br />
    } else {<br />
      tooltip.tip.className = tooltip.tip.className.replace(/ ?(_above|_below) ?/g, '') + ' _above';<br />
    }<br />
  };<br />
  var resize_tooltips = function() {<br />
    if (_removed) return;<br />
    for (var i = 0; i < tooltips.length; i++) {<br />
      if (!tooltips[i].no_arrow) resize_tooltip(tooltips[i]);<br />
    }<br />
  };<br />
  var validate_field = function(elem, remove) {<br />
    var tooltip = null, value = elem.value, no_error = true;<br />
    remove ? remove_tooltip(elem) : false;<br />
    if (elem.type != 'checkbox') elem.className = elem.className.replace(/ ?_has_error ?/g, '');<br />
    if (elem.getAttribute('required') !== null) {<br />
      if (elem.type == 'radio' || (elem.type == 'checkbox' && /any/.test(elem.className))) {<br />
        var elems = form_to_submit.elements[elem.name];<br />
        if (!(elems instanceof NodeList || elems instanceof HTMLCollection) || elems.length <= 1) {<br />
          no_error = elem.checked;<br />
        }<br />
        else {<br />
          no_error = false;<br />
          for (var i = 0; i < elems.length; i++) {<br />
            if (elems[i].checked) no_error = true;<br />
          }<br />
        }<br />
        if (!no_error) {<br />
          tooltip = create_tooltip(elem, "Please select an option.");<br />
        }<br />
      } else if (elem.type =='checkbox') {<br />
        var elems = form_to_submit.elements[elem.name], found = false, err = [];<br />
        no_error = true;<br />
        for (var i = 0; i < elems.length; i++) {<br />
          if (elems[i].getAttribute('required') === null) continue;<br />
          if (!found && elems[i] !== elem) return true;<br />
          found = true;<br />
          elems[i].className = elems[i].className.replace(/ ?_has_error ?/g, '');<br />
          if (!elems[i].checked) {<br />
            no_error = false;<br />
            elems[i].className = elems[i].className + ' _has_error';<br />
            err.push("Checking %s is required".replace("%s", elems[i].value));<br />
          }<br />
        }<br />
        if (!no_error) {<br />
          tooltip = create_tooltip(elem, err.join('<br/>'));<br />
        }<br />
      } else if (elem.tagName == 'SELECT') {<br />
        var selected = true;<br />
        if (elem.multiple) {<br />
          selected = false;<br />
          for (var i = 0; i < elem.options.length; i++) {<br />
            if (elem.options[i].selected) {<br />
              selected = true;<br />
              break;<br />
            }<br />
          }<br />
        } else {<br />
          for (var i = 0; i < elem.options.length; i++) {<br />
            if (elem.options[i].selected && !elem.options[i].value) {<br />
              selected = false;<br />
            }<br />
          }<br />
        }<br />
        if (!selected) {<br />
          elem.className = elem.className + ' _has_error';<br />
          no_error = false;<br />
          tooltip = create_tooltip(elem, "Please select an option.");<br />
        }<br />
      } else if (value === undefined || value === null || value === '') {<br />
        elem.className = elem.className + ' _has_error';<br />
        no_error = false;<br />
        tooltip = create_tooltip(elem, "This field is required.");<br />
      }<br />
    }<br />
    if (no_error && elem.name == 'email') {<br />
      if (!value.match(/^[+_a-z0-9-'&=]+(.[+_a-z0-9-']+)*@[a-z0-9-]+(.[a-z0-9-]+)*(.[a-z]{2,})$/i)) {<br />
        elem.className = elem.className + ' _has_error';<br />
        no_error = false;<br />
        tooltip = create_tooltip(elem, "Enter a valid email address.");<br />
      }<br />
    }<br />
    if (no_error && /date_field/.test(elem.className)) {<br />
      if (!value.match(/^dddd-dd-dd$/)) {<br />
        elem.className = elem.className + ' _has_error';<br />
        no_error = false;<br />
        tooltip = create_tooltip(elem, "Enter a valid date.");<br />
      }<br />
    }<br />
    tooltip ? resize_tooltip(tooltip) : false;<br />
    return no_error;<br />
  };<br />
  var needs_validate = function(el) {<br />
    return el.name == 'email' || el.getAttribute('required') !== null;<br />
  };<br />
  var validate_form = function(e) {<br />
    var err = form_to_submit.querySelector('._form_error'), no_error = true;<br />
    if (!submitted) {<br />
      submitted = true;<br />
      for (var i = 0, len = allInputs.length; i < len; i++) {<br />
        var input = allInputs[i];<br />
        if (needs_validate(input)) {<br />
          if (input.type == 'text') {<br />
            addEvent(input, 'blur', function() {<br />
              this.value = this.value.trim();<br />
              validate_field(this, true);<br />
            });<br />
            addEvent(input, 'input', function() {<br />
              validate_field(this, true);<br />
            });<br />
          } else if (input.type == 'radio' || input.type == 'checkbox') {<br />
            (function(el) {<br />
              var radios = form_to_submit.elements[el.name];<br />
              for (var i = 0; i < radios.length; i++) {<br />
                addEvent(radios[i], 'click', function() {<br />
                  validate_field(el, true);<br />
                });<br />
              }<br />
            })(input);<br />
          } else if (input.tagName == 'SELECT') {<br />
            addEvent(input, 'change', function() {<br />
              validate_field(this, true);<br />
            });<br />
          }<br />
        }<br />
      }<br />
    }<br />
    remove_tooltips();<br />
    for (var i = 0, len = allInputs.length; i < len; i++) {<br />
      var elem = allInputs[i];<br />
      if (needs_validate(elem)) {<br />
        if (elem.tagName.toLowerCase() !== "select") {<br />
          elem.value = elem.value.trim();<br />
        }<br />
        validate_field(elem) ? true : no_error = false;<br />
      }<br />
    }<br />
    if (!no_error && e) {<br />
      e.preventDefault();<br />
    }<br />
    resize_tooltips();<br />
    return no_error;<br />
  };<br />
  addEvent(window, 'resize', resize_tooltips);<br />
  addEvent(window, 'scroll', resize_tooltips);<br />
  window._old_serialize = null;<br />
  if (typeof serialize !== 'undefined') window._old_serialize = window.serialize;<br />
  _load_script("//d3rxaij56vjege.cloudfront.net/form-serialize/0.3/serialize.min.js", function() {<br />
    window._form_serialize = window.serialize;<br />
    if (window._old_serialize) window.serialize = window._old_serialize;<br />
  });<br />
  var form_submit = function(e) {<br />
    e.preventDefault();<br />
    if (validate_form()) {<br />
      // use this trick to get the submit button & disable it using plain javascript<br />
      document.querySelector('[id^="_form"][id$="_submit"]').disabled = true;<br />
            var serialized = _form_serialize(document.getElementById('_form_1_'));<br />
      var err = form_to_submit.querySelector('._form_error');<br />
      err ? err.parentNode.removeChild(err) : false;<br />
      _load_script('https://netimpactmarketing.activehosted.com/proc.php?' + serialized + '&jsonp=true');<br />
    }<br />
    return false;<br />
  };<br />
  addEvent(form_to_submit, 'submit', form_submit);<br />
})();</p>
<p></script>[/custom_html]

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