Consultation Request Form (CRF)

FIRST NAME * PREFERRED NAME * LAST NAME *

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EMAIL ADDRESS * ADDRESS1 * RESIDENCE *

programmer13@dynamicdreamz.com gfdgdfg OWN
RENT
CITY * STATE* ZIP/POSTAL CODE *
dfgfdgdfgdfg Kansas KS dfgdfgdfgfdg

HOW LONG AT CURRENT RESIDENCE * EQUIZ SCORE WORK PHONE *

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HOME PHONE * MOBILE PHONE * BEST WAY TO REACH YOU *

gdfgdfggd fgdfgdfgdfgfd Home Phone

IF MARRIED, SPOUSE’S NAME &

MARITAL STATUS DATE OF BIRTH *
OCCUPATION
Single gdfgdfgdfg 15-Jan-2014

NUMBER OF CHILDREN/DEPENDENTS CHILDREN'S AGES HIGHEST EDUCATION COMPLETED *

345345 gdfgdfgdfgd High School

OTHER EDUCATION AND

HOW DID YOU LEARN ABOUT US? * CURRENT EMPLOYER AND POSITION*
CERTIFICATIONS
534534 gfgdfgdfg dfgdfgdfgdgdfg

WHICH BEST DESCRIBES YOUR CAREER HAVE YOU EVER OWNED YOUR OWN
HOW LONG AT CURRENT EMPLOYER ? *
STRATEGY * BUSINESS? *
432423 Looking at both
employment/self-employment YES
options equally NO

IF 'YES", WHAT TYPE OF BUSINESS AND HOW LONG HAVE YOU BEEN LOOKING PLEASE LIST ALL THE BUSINESSES YOU
WHEN? FOR A BUSINESS? * HAVE LOOKED AT
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PREFERRED MARKET 1ST* PREFERRED MARKET 2ND* PREFERRED MARKET 3RD*

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WHAT PROFESSIONAL AFFILIATIONS

AND/OR HOBBIES DO YOU HAVE?
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WHAT ARE YOU LOOKING FOR FROM YOUR OWN BUSINESS THAT YOU HAVEN’T BEEN ABLE TO ACHIEVE IN
CURRENT/PAST EMPLOYMENT? (CHECK ALL THAT APPLY) *
 YOUR OWN BOSS CAREER STABILITY FINANCIAL INDEPENDENCE
FLEXIBLE SCHEDULE/LIFE
LESS TRAVEL NEW CHALLENGES
BALANCE
BUILD EQUITY LEAVE A LEGACY BUILDING MY OWN TEAM
ESCAPE FROM CORPORATE
MORE COMMUNITY INVOLVEMENT SMALL BUSINESS TAX BENEFITS
POLITICS
BETTER INCOME POTENTIAL OTHER (PLEASE EXPLAIN)
OTHER (PLEASE EXPLAIN) *

IF YOU WERE A FRANCHISOR, WHY

WOULD SOMEONE LIKE YOURSELF
MAKE AN EXCELLENT FRANCHISEE
CANDIDATE, RELATIVE TO ALL
OTHER APPLICANTS? *
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DO YOU AND/OR YOUR SPOUSE
HAVE ANY RESERVATIONS ABOUT
OWNING YOUR OWN BUSINESS? *
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YOUR IDEAL BUSINESS MODEL

Describe some of the things that are important to you in selecting a business. The more you tell me, the better I am able to help you.

I WANT SOMETHING DIRECTLY

MY INITIAL INVOLVEMENT WOULD BE THE LIFECYCLE OF THE FRANCHISE
RELATED TO MY INDUSTRY
AS * BRAND I WANT*
BACKGROUND *
Owner Operator Absolutely Ground Floor(less than 2 years in
opt)

INDUSTRY SEGMENTS
CLEANING
AUTOMOTIVE * BUSINESS TO BUSINESS SERVICES * SERVICES–RESIDENTIAL/COMMERCIAL
*
Strong Interest Strong Interest Strong Interest

CONSULTING AND COACHING * CHILD DEVELOPMENT * EMPLOYMENT & STAFFING *

Strong Interest Strong Interest Neutral Interest

FINANCIAL SERVICES * FOOD & CATERING * HAIR & BEAUTY *

Strong Interest Strong Interest Neutral Interest

HEALTH, FITNESS & WELLNESS * HOME SERVICES * MARKETING & ADVERTISING *

Strong Interest Strong Interest) Strong Interest

PACKAGING & MAILING * PET SERVICES * PRINTING, SIGNS & GRAPHICS *

Strong Interest strong interest Neutral Interest

REAL ESTATE SERVICES * RETAIL * SENIOR SERVICES *

Strong Interest Strong Interest Strong Interest

SPORTS & RECREATION * TECHNOLOGY & COMPUTERS

Neutral Interest Strong Interest

YOUR COMPANY'S OFFERING *
A service
MY SALES ABILITY IS *
Very Weak
I WANT TO EVENTUALLY HAVE
MULTIPLE LOCATIONS *
Definitely
# OF EMPLOYEES *
0 Spouse
YOUR NEED FOR FINANCING THE
BALANCE OF THE TOTAL INVESTMENT *
Definite
WHO WILL BE INVOLVED IN THE
DECISION PROCESS?(CHECK ALL)? *
MYSELF
SPOUSE
OTHER
WHAT DID YOU LIKE MOST ABOUT YOUR WHAT DID YOU LIKE LEAST ABOUT
PAST JOBS OR BUSINESSES? *
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WHAT SHOULD THE FRANCHISOR
EXPECT FROM YOU? *
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BUYER CORE VALUES
BUSINESS LOCATION IS BASED AT *
An office
MY SALES INTEREST IS *
Very Weak
# HOURS YOU CAN DEVOTE PER WEEK
(DURING LAUNCH PHASE) *
0-20
FRIENDS / FAMILY INVOLVEMENT
(CHECK ALL) *
DECISION TIMEFRAME *
1-3 months
HOW WILL YOU KNOW WHEN YOU’VE
FOUND THE RIGHT BUSINESS? *
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YOUR PAST JOBS, OR BUSINESSES? *
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DESCRIBE THE TIMES (PROJECTS,
BUSINESSES, ETC) WHERE YOU HAVE
DEMONSTRATED ENTREPRENEURIAL
CAPABILITIES?
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I WANT A FRANCHISOR WITH *
Strong support systems however
with restrictions and less creative
latitude
TYPE OF WORK ENVIRONMENT *
Suit and tie
EMPLOYEE PROFILE *
Salaried
YOUR COMFORTABLE CASH/DOWN
PAYMENT INVESTMENT LEVEL *
$150K+
TIMEFRAME TO OPEN YOUR BUSINESS *
1-3 months
IF YOU HAVE LOOKED AT OTHER
BUSINESSES BEFORE, WHAT MADE YOU
ULTIMATELY NOT DECIDE TO
PURCHASE THEM? *
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WHAT ARE YOUR EXPECTATIONS OF
THE FRANCHISOR? *
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DESCRIBE THE RESULTS YOU
ACHIEVED AND/OR YOUR COMPANY
ACHIEVED FROM THOSE PROJECTS,
BUSINESSES, ETC.
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FINANCIAL INFORMATION
CASH IN CHECKING 121 NOTES PAYABLE TO 21
ACCOUNT * BANKS *

CASH IN SAVINGS 2 NOTES PAYABLE TO 2

ACCOUNT * FINANCE COS.*

121 CHARGE ACCOUNTS * 12

STOCK AND BONDS *

21 CREDIT CARDS * 12
IRAS *

2 TAXES PAYABLE * 12
401KS *

CASH SURRENDER VALUE 12 OWING ON LIFE 12

OF LIFE INS. * INSURANCE *

REAL ESTATE VALUE, 12 MORTGAGE, 1

HOME * RESIDENCE *

REAL ESTATE VALUE, 12 MORTGAGE, 21

OTHER * OTHER *

12 DUE ON 21
AUTOMOBILE(S) *
AUTOMOBILES *

12 DUE ON OTHER VEHICLES * 2

OTHER VEHICLES *

EQUITY IN YOUR OWN 12 OTHER LIABILITY - 12

BUSINESS *

APPRAISED 1 OTHER LIABILITY - 12

COLLECTIBLES *

21 OTHER LIABILITY - 12
MONEY DUE TO YOU *

OTHER ASSETS 21 OTHER LIABILITY - 12

(COMBINED) *

12 TOTAL LIABILITIES 164

TOTAL ASSETS

TOTAL NET WORTH -152

DO YOU HAVE A FINANCIAL PARTNER OR ANY OTHER

IF YES, PLEASE EXPLAIN
PERSONAL SOURCE OF INVESTMENT CAPITAL? *
YES sdfsdfsd
NO

DO YOU HAVE ADDITIONAL INCOME SOURCES * IF YES, PLEASE EXPLAIN

YES fsdfsdfdsfsd
NO

INCOME EXPECTATIONS AFTER 1ST

AFTER 2ND YR* AFTER 3RD YR*
YR*
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