Step 3 of 11: BUSINESS INFORMATION
Do you currently have an ownership interest in a business? If so, complete the section below. Otherwise, proceed to the next step.
Business Name & Address
Step 6 of 11: FINANCIAL INFORMATION
To complete this section, gather any relevant documentation for your financial assets. For each asset, enter the dollar amount rounded to the nearest whole dollar. (i.e. 1000 or 1,000).
ASSETS
Step 7 of 11: FINANCIAL INFORMATION
To complete this section, gather any relevant documentation for your financial liabilities.For each liability, enter the dollar amount rounded to the nearest whole dollar. (i.e. 1000 or 1,000).
LIABILITIES
Review Information
Please review your information before completing the application.
First Name:
Last Name:
Email :
Confirm Email:
Franchise Interested In:
Primary Phone Number:
Work Phone Number:
Cell Phone Number:
Fax Phone Number:
Street Address 1:
Street Address 2:
City:
State:
Zip:
Spouse Full Name:
Spouse/Partner Email:
Spouse/Partner Cell:
Best time to call:
Business Name:
Street Address 1:
Street Address 2:
City:
Why are you seeking or expanding a business of your own?:
Why are you interested in one of our franchises?:
Describe your present business and your role in it.:
What contract groups, associations, or franchises are you affiliated with?:
What are the three greatest challenges facing your business?:
If you were to start over, what would you do differently?:
what do you think makes the difference between success and failure?:
accomplishment?:
disappointment?:
encourages you the most?:
cautions you the most?:
Please organize the following aspects of your life in the order of most importance to you:
What is your succession plan (for passing your business to your heirs, for selling it, etc.)?:
Comments:
Please keep me updated by Email:
Residence:
Marital Status:
Number of Children:
Full Legal Name as it appears on identification:
Are you a U.S. or Canadian Citizen or do you have the right to legally reside (and work) in the U.S. or Canada for the duration of the franchise agreement?:*:
Are you a U.S. or Canadian military veteran?:
Have you ever been convicted or charged of a misdemeanor (other than a traffic violation)?:
Please explain (include the date, court name and location):
Have you ever been convicted of or charged with a felony?*:
Please explain (include the date, court name and location):
Have you ever been convicted or charged of DWI or DUI?:
Please explain (include the date, court name and location):
Do you have any existing or pending tax liens?:
Please explain (include the date, court name and location):
Have you ever filed or have any pending or discharged bankruptcy (personal or business)?:
Please include the year filled and name used:
Do you have any pending civil litigation (personal or business) and/or have you ever filed or had any filed against you?:
Please provide the year filed, case number, court information and parties to the suit.:
Total Capital Available for Investment:
Cash on Hand in Bank:
Primary Residence:
Commercial Real Estate:
Other Real Estate:
Business Value:
Automobiles:
Personal Property:
Marketable Securities:
Notes Receivable:
Retirement Fund:
Profit Sharing:
401(k):
IRA:
Name:
Value:
Name:
Value:
Name:
Value:
Yearly Income:
Spouse Income:
Your Summary: Total Assets
Total Assets Total Liabilities
Total Liabilities Net Worth
Net Worth
Mortgage Balance:
2nd Mortgage Balance:
Lines of Credit:
Business Loans:
Credit Cards:
Vehicle Loans:
School Loans:
Name:
Value:
Name:
Value:
Name:
Value:
Name:
Value:
Name:
Value:
Name:
Value:
Name:
Value:
YOUR SUMMARY: Total Assets
Total Assets Total Liabilities
Total Liabilities Net Worth
Net Worth
Employer Name:
Address 1:
Address 2:
City:
State:
ZIP:
Start Date:
End Date:
Salary:
Position:
Reason for Leaving:
Employer Name:
Address 1:
Address 2:
City:
State:
Zip:
Start Date:
End Date:
Salary:
Position:
Reason for Leaving:
Highest Education Level:
College/University:
Major:
Years Attended:
Degree:
Reference Name:
Reference Phone:
Best time to contact:
Reference Name:
Reference Phone:
Best time to contact:
Referrence Name:
Reference Phone:
Best time to Contact:
When would you be available to visit Neighborly® corporate headquarters? :When would you be available to start your franchise?: *:
1.:
2.:
3.:
How did you hear about us?:
