Lead Personal Profile


Fields marked with * are mandatory.


Personal Information
First Name : Last Name : Gender : MaleFemale Address : How many years at this address? : City : Country : State / Province : Zip / Postal Code : County : Home Phone : Home Phone Extension : Country : Home Ownership : OwnRenting Email : Birth Date : Spouse Name : How did you hear about us? : Best Time To Contact : Can you devote your full time to the business? : YesNo Are there any other franchise opportunities that you are looking into? : Marital Status : SingleMarried How long have you wanted to operate your own franchise? :

Employment

Present Employer :
Percent of Company you own :
Title :
Date Started :
Address :
City :
Country :
State / Province :
Zip / Postal Code :
Business Phone :
May we call you at work ? : YesNo
Hours Per Week :
Salary (ex. $ 100,000.00/year) :
/year
Brief description of your responsibilities :
Have you previously ever been self-employed? : YesNo
Have you ever signed a contract or non-competitor agreement that might limit or disqualify you from owning/operating a franchise? : YesNo
Have you ever owned, operated or worked with any firm that provides products or services similar to ours? : YesNo

Finance

Cash on Hand & in Banks ($) :
Will you have a partner? : YesNo
How long can you support yourself and your family without making withdrawls from your business (in years)? :
How would you finance your franchise? :
Income from present occupation ($) :
/year
If other income, explain :
Spouse/Other Income ($) :
/year


Specified Data
Would this business be your sole source of income? : YesNo If qualified, when would you be ready to start your Franchise Business? : Do you intend to run this business yourself? : YesNo If not, who will be responsible for the daily operation of your business? : Have you ever been convicted of a felony? : YesNo Do you have any contingent liabilities for guarantees, endorsements, leases etc.? : YesNo Have you or any company you have owned or managed ever gone through bankruptcy or compromised a debt? : YesNo Are you now, or have you ever been party to any lawsuit - either as defendant or plaintiff? : YesNo Have you ever been convicted? : YesNo


Other Comments
How does your spouse and family feel about your being in business for yourself? : Other facts you want us to know : Captcha ( Enter the text you see in the image below ) Captcha