Many of the questions in this form are optional. Please share as much information as you can. The more I learn about you, the more I can help you find a great fitting franchise!

Consultant's Name: Chris Bushey

Consultant's Email: [email protected]

You

First Name *

Last Name *

Nickname *

Age *

Your Spouse

Spouse's name

Spouses Age

Names and Ages of Dependents

Address

Street Address *

City *

State *

Postal Code *

Years of Residency *

Contact Info

Phone *

Email *

Activities, Hobbies, Interests *

Employment - You

Company

Position

Duties

Annual Compensation

Employment - Spouse

Spouses Company

Spouses Position

Spouses Duties

Spouses Annual Compensation

Ownership Preferences

Have you ever owned a business? *

Yes
No
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Please give details:

How long have you been looking for a business?

What other businesses have you investigated?

Area Preferred (cities/states) *

Are you seeking a single franchise or multiple units? *

When would you like your first franchise to open? *

Would your involvement in the business be FULL TIME or PART TIME? *

Full time
Part time
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What attracts you owning a franchise?

To escape the corporate world and be my own boss

To build a legacy for my family

to pursue a passion and make a difference in my community

All of the above

What have you liked most and least about past jobs?

What are your strengths relating to managing a business?

What are your major questions or concerns about business ownership? *

What do you foresee your role in the business being?

How would you rate your sales interest or ability? *

High
Medium
Low
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How would you rate your people management interest or ability? *

High
Medium
Low
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How would you rate the importance of Status (what others think) in the selection of a business? *

High
Medium
Low
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How important is it to be able to grow additional units/territories? *

High
Medium
Low
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Are there any types of businesses that you are certain you would not be interested in? Why? *

What else should we know in order to help you find a great business for you? (The Perfect Fit) *

Assets

Cash or Equivalents

$

Savings / Certificates

$

Stocks, Bonds, Securities

$

Retirement Plans (IRA/401K)

$

Home market value

$

Other Real Estate

$

Other assets

$

Auto

$

Other Assets Description

Total assets

Liabilities:

Credit Card Balances

$

Home Mortgage Balance

$

Other Real Estate Debts

$

Auto loans

$

Other debts

$

Other Debt Description

Total Liabilities

Net Worth

What is your total investment exposure comfort level? (Total of down payment and amount financed) *

$50,000 - $100,000
$100,000 - $200,000
$200,000 - $300,000
$300,000 - $500,000
Over $500,000
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The income you need to make once the business is up and running (assume after year 3) *

$

Is your credit rating above 685? Yes/No? *

Yes
No
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Time you can go without an income while you build your business *

Other

Are either you or your spouse a veteran?

Yes

No

Do you plan to have a partner?

Yes

No

Do you plan to have investors?

Yes

No

If partner or investor will be active in the business, please explain:

Have you or your spouse ever been involved in a personal or business bankruptcy? *

Yes

No

Have your or your spouse ever been convicted of a crime? *

Yes

No

Are you or your spouse currently under any type of criminal investigation? *

Yes

No

Are you or your spouse currently involved in any pending civil lawsuits? *

Yes

No

Are you or your spouse subject to any civil judgements *

Yes

No

Please explain any affirmative answers to the previous 5 questions:

By providing your phone number and submitting this form, you agree to receive text messages and phone calls from our business, including automated, pre-recorded, or AI-generated calls for informational and marketing purposes. Message and data rates may apply. You also consent to receive marketing communications about our products and service via voice, text, or other electronic means. Consent is not a condition of purchase. You may opt out of reciving message s at any time by replying STOP to any text message or by contacting us directly.