Confidential Questionnaire

PERSONAL INFORMATION:

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First Name *

Last Name *

Spouse's Name

ADDRESS:

Street Address *

Address Line 2

City *

State *

Postal / Zip Code *

Preferred Email *

Cell Phone *

EMPLOYMENT:

What is your current employment situation?

Employed full-time

Employed part-time

Unemployed

Self-employed

Your current position and responsibilities:

Spouse's current position and responsibilities:

Which best describes your management ability?

I love managing and coaching people.

I am a good manager.

I manage others because I need to.

I dislike managing people.

Which best describes your sales skills?

I consider myself a salesperson. I love cold calling and networking.

I am good at sales and like networking, but do not like cold calling.

I am good at selling to people who have expressed an interest in my product or service.

Sales is not for me. I prefer to focus on the operations of a business.

Have you ever owned a business?

Yes

No

Why are you interested in owning a business now?

Do you plan to work full-time in the business?

Yes

No

Unsure

ADDITIONAL INFORMATION:

Are you a veteran?

Yes

No

Will you have a partner or investors?

Yes

No

Have you or your spouse been involved in a bankruptcy?

Yes

No

Have you or your spouse been convicted of a crime?

Yes

No

APPROXIMATE NET WORTH (includes stocks, bonds, & cash, home and real estate equity, retirement funds such as 401k and IRA):

What is your credit score?

Under 700

700-750

Over 750

Would you like information on a service that offers an IRS-approved option for using all or part of your 401k/IRA to fund your new business with no penalty for early withdrawal, and that would shield you from capital gains taxes?

401k/IRA Funding Info:

Yes

No

Invest in a franchise brand that satisfies your life and financial needs.

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