Questionnaire (page 2 0f 3)
Please Answer All Fields Below.

Full Name     Age     Marital Status     No. of Dependents    
Address     City     State     Zip    
Own     Rent     Years    
Home Phone     Business Phone     Cell Phone    
Email     Fax     Best To Call    

EMPLOYMENT/BUSINESS RECORD
(We Will Not Contact Your Current Employer Without Your Approval)

Current Employer     Current Position     Years    
Previous Employer     Previous Position     Years    
Business Name     Industry    

PERSONAL REFERENCES
(Please List Two People That You Have Known You For Two Or More Years)

Name     Phone     Years known    
Address     City     State     Zip    
Name     Phone     Years known    
Address     City     State     Zip    

FINANCIAL DATA
(Your Personal Financial Statement May Be Requested At Our First Meeting)

Your approximate net worth?     Name of Partner/Investor (if any)    
How will you obtain cash and/or credit to manage the average $250,000 investment required? Please be specific. (If applying for an SBA loan, you must have at least $80,000 cash to qualify.)

BUSINESS HISTORY
(Please Have A Resume Available At Our First Meeting)

Do you now own a franchise business?     Name of franchise    
Have you ever failed in business?     Compromised with creditors or filed bankruptcy? 
Detail of bankruptcy
Have you ever been involved in litigation regarding your business interests?    
Detail of bankruptcy

MARKET PREFERENCE
(Large Markets Or Cities May Be Divided Into Smaller Territories)

First choice for your location?     Second choice?    
When do you want to begin?
Now  3 to 6 month  6 to 12 months    Other 
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