Personal Information First Name Last Name Email Gender:--None--Male Female Phone Mobile Street City State/Province Zip Code: Birth Date: Home Ownership: --None-- Own Rent Marital Status:--None--Married Single Other Spouse Name: Spouse Birth Date: Assets and Liabilities Assets Cash on Hand & In Banks ($): Marketable Securities ($): Accounts / Notes Receivable ($): Retirement Plans ($): Real Estate ($): Personal Property ($): Business Holdings ($): Life Insurance ($): Other Assets ($): Liabilities Mortgages ($): Accounts/ Notes Payable ($): Credit Cards (total balance) ($): Other Liabilities ($): Annual Sources of Income Salary ($): Investments ($): Real Estate Income ($): Other ($): Specifics What is your timeline for investing in your future, with this opportunity, if you are awarded a franchise? What skills / experience do you have that will help you be successful in this business? How will this franchise enable you to reach your personal goals? Who will be responsible for the daily operation of your studio? Have you been approved for financing?--None--Yes No Amount Approved ($): Area / Location Preference 1: Area / Location Preference 2: Area / Location Preference 3:
