Personal Information First Name*: Last Name*: Email*: (we will keep your email completely private) Will Your Spouse/Partner Be Involved In The Franchise: YESNO Partner's Name: Number of Dependents and Ages: Name Age Contact Information Primary Number: Best Time To Call: Address*: City*: State*: Zip*: Current Employment Situation Currently I Am: EMPLOYEDSELF-EMPLOYEDNOT WORKING Current Compensation: Monthly Spouse or Partner's Employment Status: EMPLOYEDSELF-EMPLOYEDNOT WORKING Spouse or Partner's Compensation: Monthly General Information Have You Owned your Own Business? Please Describe: Financial Information. Please provide number in complete dollars Assets Cash on Hand $ Stocks and Bonds $ 401k an IRA $ Primary Residence Value $ Other Real Estate $ Autos $ Other Assets $ Total Assets $ Liabilities Notes payable $ Credit Card Balances $ Primary Residence Mortgage $ Other Real Estate Debt $ Auto Loans $ Other Debt $ Total Liabilities $ Additional Sources of Income (Monthly) Bonuses/commissions $ Real Estate Income $ Dividends/interest $ Other $ Total Additional Income $ Other Considerations Have You or Your Partner/Spouse Ever Been Involved In a Bankruptcy? NOYES Do You or Your Partner/Spouse Have Any Judgments, Liens or Lawsuits Pending? NOYES Have You or Your Spouse Ever Been Convicted of a Felony? NOYES
