FRANCHISEE EVALUATION FORM
Aplicant’s Name: ________________________________
Address : ________________________________
Home Phone: ____________ Office: ________________
Cell Phone: ____________ Email: _________________
Employment History:
1.
2.
3.
General Education:
High School:
College:
Additional Degree:
Please give Full details.
OTHER PRINCIPALS AND MANAGEMENT
Investor/Associate who will join you in this venture. Please have each fill out one of these forms.
No |
Individual |
Address |
% of Ownership |
Percentage of time involved |
1. |
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2. |
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3. |
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4. |
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PERSONAL AND PROFESSIONAL REFERENCES
1.
2.
3.
4.
PLEASE INCLUDE FULL NAME,ADDRESS AND CONTACT DETAILS.
MONTHLY INCOME
Assests Laiabilities
Cash |
$ |
Secured notes payable to others |
$ |
Maketable securities |
$ |
Unsecured notes payable to others |
$ |
Non-readily marketable securities |
$ |
Accounts payable |
$ |
Accounts & notes receivable |
$ |
Margin accounts |
$ |
Net cash surrender value of life insurance |
$ |
Notes due: partnership |
$ |
Residential real estate |
$ |
Taxes payable |
$ |
Real estate investment |
$ |
Mortgage debt |
$ |
Partnership/PC interests |
$ |
Life insurance loans |
$ |
IRA, Profit sharing,other vested retirement accounts |
$ |
Other liabilities |
$ |
Deferred income |
$ |
|
|
Personal Property |
$ |
|
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Other assets |
$ |
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|
Total assests |
$ |
Total Liabilites |
$ |
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TOTAL NET WORTH |
$ |
*Will the franchise business be your sole source of income?_____________
*Total unencumbered liquid capital readily available for use in the franchise business?______________________
*What is the source of this unencumbered liquid capital?________________
*How do you anticipate financing the balance of the total initial investment?___________________
*How many hours per week do you anticipate working in your business?_______
*In what city (Cities) would you like to open your franchise?_______________
*Would you be willing to consider other areas to open your franchise? What areas______________
*How soon would you be prepared to open your franchise?________________
*When would you be available to meet with one of our representatives?_______
*What questions would you like answered during your meeting with our representative?_________________________________________________
***Please describe in details why you will be a good candidate to become An SIG Franchisee.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I hereby certify that the information supplied in this Franchise Evaluation Form and other financial statements made by me are true and correct. I agree to have all information confirmed by one of your representaties and I authorize you to check references and conduct such addtional credit checks as deemed. I further understand that submission of this information does not obligate either parties to purchase or sell a franchise.
_____________________ _____________________
Applicant’s Signature Date