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Confidential Questionnaire

Please complete the following confidential questionnaire. Fields marked with * are required.

Choose Submission Method Complete Online Form Download, Complete & Upload Form

Download and Upload Form

Download the Confidential Questionnaire, complete it, and upload the completed file below.

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20%

Step 1: Personal Information Name: * Name is required. Spouse / Partner: Street Address: * Street address is required. City / State / ZIP: * City / State / ZIP is required. Email Address: * Please enter a valid email address. Phone Number: * Phone number is required.

Best Time to Call:

Day / Evening:

Cell:

Marital Status:

Number of Dependents:

Ages:

Step 2: Employment History Employment History: Current Business or Employment:

Position:

Annual Salary:

Spouse / Partner Employment History

Spouse / Partner Employment History: Current Business or Employment:

Position:

Annual Salary:

Step 3: Business and Management Goals What Role Will Your Spouse Play in this Business:

Do you plan to devote your full time to this business venture? Yes No

Will your spouse/partner be active in the franchise? Yes No

Will this franchise be your primary source of income? Yes No

Have you ever owned a business? Yes No

Step 4: Financial Statement

Assets

Cash on Hand: Home: Stocks and Bonds: Personal Property: Autos: Other Real Estate: Retirement (401K, IRA, etc.): Total Assets (A):

Liabilities

Installment Notes & Contracts: Real Estate Loans: Bills Payable: Other: Total Liabilities (B):

Total Assets (A): $0.00

- Total Liabilities (B): $0.00

= Net Worth: $0.00

Step 5: Credit Information & Signature Credit Score:

Have you ever filed for bankruptcy? Yes No

Signature: Date:

We help organizations to achieve their dreams by empowering them to meet their short term and long term goals.

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Call : 503-296-1111

Mail : Thelairdcorporation@gmail.com

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