Confidential Intake Form & Financial Statement

Personal Information

Your Name

First Last

Spouse/Partner's Name

First Last

Address

Street Address Address Line 2 City State/Region/Province Postal / Zip Code

Country

Cell Phone Number *

Your Preferred Email *

Spouse's Preferred Email *

Your current position and responsibilities:

Your spouse/partners's current position and responsibilities:

Ownership Preferences

Why are you interested in owning a business?

What is your VISION for yourself/your family in starting a business?

Additional Information

Is your spouse active duty or a veteran?

Are you planning on having a partner or investor?

Have your or your spouse been involved in a bankruptcy? *

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

Financial Information

This information is important for matching purposes and because franchisors/business opportunies have minimum net worth and liquidity requirements for their brands. Financial numbers may be approximate.

Approximate Net Worth *

Includes stocks, bonds and cash, home and real estate equity, retirement funds such as 401ks and IRAs.

Your Income Range

Approximate FICO Credit Score *

Cindy Rayfield's Confidential Intake Form

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