The information you provide in this form is not binding and in no way obligates you or FRANCHISEMART to purchase a franchise. Its purpose is to provide our company with the pertinent information that can help match your goals with a franchisor. All information is secured and treated with strict confidentiality.

PERSONAL DATA

First Name:			Last Name:
Spouse First Name:			Spouse Last Name:
Address:
Address 2:
City:
State:		Please Select Outside US Alaska Alabama Arkansas American Samoa Arizona California Colorado Connecticut District of Colombia Delaware Florida Federated States Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virgin Islands Vermont Virginia Washington Wisconsin West Virginia Wyoming	Zip/Postal Code:

Home Phone:			Best time to call:
Business Phone			Best time to call:
Cell Phone			Best time to call:
Email:

BUSINESS BACKGROUND

Explain your business background and experience. Please include any management experience

If you have owned your own business please explain the type of business, how long you operated the business and your role within the business.

ABOUT YOU

How long have you been interested in owning your own business?

Before coming to FRANCHISEMART had you considered other franchises? Yes   No If yes, please indicate the franchises

Have you ever worked with a business broker: Yes    No

What industries interest you most?

When do you want to open your franchise?   Please Select ASAP 3 Months 6 Months 12 Months Over 12 Months

In which geographical area(s) would you like to open your franchise?

Do you plan to have a partner or family member involved in the franchise?   Yes    No If yes, will the partner be active Yes    No

Are you interested in opening more than one location?   Yes   No If yes, how many locations

Are you interested in obtaining a regional or master license?   Yes   No

What languages do you speak?

If you are currently employed, would you be leaving your job?   Yes   No

There are some home based franchises that allow for you to retain your current employment. Would you be interested in learning more about these franchises?   Yes   No

What sources(s) of income do you have available?

What is your total annual income? (optional)

What investment level are you considering?   Please select Up to $10,000 Up to $25,000 Up to $50,000 Up to $100,000 Up to $150,000 Up to $200,000 Over to $200,000

Would you like FRANCHISEMART to assist you with financing?   Yes, I would like more information   No

Where is the ideal place for you to do business? Please check all that apply. Office Retail Location Home Actively Calling On Businesses Not A Consideration Other

Indicate your preference regarding employees.  Please select I want to work with numerous employees I only want to have a few employees I want to work by myself

Which management style do you prefer?  Please select I want to be heavily involved in all areas of the business I want to manage employees and delegate duties so I may build the business

Select which hours you desire to work. The hours it will require to launch the business Nights or weekends, if required by the business 9:00 AM until 5:00 PM Monday through Friday Actively Calling On Businesses I am keeping my current job and will be working part-time at the franchise Other

Most businesses have three main skill components: sales, management and operations. Which components are you most comfortable with why?

Please indicate other information that would help us find your best franchise opportunity.