AT Franchise Consultants
Franchise Qualification Questionnaire

To see how this form will be used, see Franchise Application Process
Privacy Policy: Your information will be held in strict confidence and never sold to any party under any circumstances.
* Required Fields

Personal Information
*First Name:
*Last Name: Middle: *Date of Birth:
*Address:
*City: *State :
*County:
*Zip Code: *Email:
*Home/Work Phone:
*Cell Phone:
Social Security #:
Drivers License # / State Issued:
*Are you U.S Citizen?
*Marital Status:
Spouse Name:Last
First Middle Date of Birth:
Education
Highest Grade Completed:
High School: College Level:
List Name(s) of Colleges/Universities Attended
Colleges/University: Dates Attended : List Degree:
Colleges/University: Dates Attended : List Degree:
Business History - Employment
*Company:
*Dates: *Title: *Business Type: *Annual Salary:
Company:
Dates: Title: Business Type: Annual Salary:
Company:
Dates: Title: Business Type: Annual Salary:
Do you or have you ever owned any other business not listed above? If so what was the business?
General
Do you plan to operate the business yourself? If not, who will? Do you intend to have a partner?
Please list the areas of preference for your franchise.
*City/State/County City/State/County City/State/County
Why do you wish to purchase a franchise?
If your application is approved, when would you like to open your business?
Please list out any business or franchise categories that interest you.
Please list out the years of experience you have in each of the following business areas.
Sales Marketing Management Administration Accounting/Finance
List out any special skills, skilled craftsmanship, or certifications that you have.

Financial
Assets
   
Cash on Hand and in Banks
$    
U.S. Government Securities
$    
Accounts, Loans and Notes Receivable
$
   
Cash Surrender Value Life Insurance
$
   
Value of Businesses Owned
$
 
Other Stocks and Bonds
$
Liabilities  
Real Estate
$
Notes Payable $
Automobiles – Number ( )
$
Real Estate Notes Payable $
Household Furnishings & Personal Effects
$
Total Credit Card Debt $
Other Assets (itemize)
$
Other Liabilities & Debt (itemize) $
Total Assets:
$
Total Liabilities:
 $
Net Worth (Assets minus Liabilities): $
Sources of Income
   
Salary $    
Spouse $    
Dividends and Interest $    
Bonus and Commissions $    
Other Income $    
Total Income $    
How much money are you prepared to invest in the franchise? $
Where will the funds come from?
Have you ever declared bankruptcy?

Comments:

The undersigned certifies that the information provided in this franchise qualification questionnaire is complete and accurate.
I hereby authorize verification of the above information from credit reporting agencies. It is understood that this is a
preliminary application and does not bind any party to any obligation.
 
Signature
 *Print Your Name *Date