First Name
Last Name
Email
Phone
Address
Years at this address
Current Occupation
Years in Current Occupation
Highest Level of Education
Birthdate
Best Time to Talk (PST)
Have you ever been convicted of a felony?
Will this be a Business Partnership?
Marital Status
Please Select
Single
Married
Divorced
Widowed
If married, will your spouse participate in the business?
Spouse Name
Spouse Email
Spouse Occupation
Spouse Length in Occupation
Spouse Income
Company Name if self employed, type "self")
Position
Start Date
End Date
Annual Income
Company Name
Position
Start Date
End Date
Annual Income
Is your objective to supplement, transition, replace current income, invest, or be actively involved? Please explain below.
Number of Developments Interested
Please Select
Single Location
Two Locations
Over Two Locations
How long have you been looking at Business Opportunities
What other businesses are you considering?
How did you hear about us?
Friend, Family, Colleague
I'm a Current Customer
Online Franchise Searches
Open House / Grand Opening
Print Advertising or PR
Seminar / Trade Show
Other
What specifically interests you about this franchise?
On a scale of 1 - 10, with 10 being the highest, how committed are you to owning your own business?
What is your timeline for starting your own business? (In months)
Why do you believe you can successfully operate and manage with our franchise?
Cash in Savings
Cash in Checking
Real Estate (Home Value)
Other Real Estate
Cash Surrender in Life Insurance
Qualified Plan Assets - Stocks/Bonds
IRA's/401K
Business Assets
Appraised Collectable Assets
Other Assets
Total Assets (sum of assets)
Notes Payable to Banks
Notes Payment to Finance Companies
Real Estate Mortgage Indebtedness
Automobile(s) Indebtedness
Owed on Life Insurance
Charge Accounts
Credit Cards
Taxes Payable
Other Liabilities
Total Liabilities (sum of liabilities)
Net Worth (Total Assets minus Total Liabilities)
What amount of money do you feel comfortable Investing?
Liquid Capital
Credit Score
Have you ever filed for bankruptcy ?
If yes, please explain
On a scale of 1 - 10, with 10 being the highest, how committed are you to moving forward with this franchise?
Disclosure Statement
I will not divulge or use any information of whatever kind used in connection with BarbaraKares, without their consent. By submitting this form, you are agreeing to receive emails and/or text messages from us.
Full Name
Today's Date
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