E-mail Address
Date of Birth (ex. 10/21/1970)
Address
City
State
ZIP (Postal Code)
Business Phone
Home Phone
Best time to call
U.S. Citizen
Country
Marital Status
Spouse's Name
Spouse's Occupation
Will your spouse be involved in the business?
Number of Dependents
Are you currently using the services of a Franchise Consultant/Coach?
Have you ever been self-employed?
What type of business?
How many years?
How long have you been looking for a business?
When do you plan to start running a franchise business?
What other businesses have you looked at?
What other businesses are you still considering?
Will you have partners? (Other than your spouse.)
What attracts you to business ownership and what are you looking for (expecting) in owning your own business?
What part will you play in the business?
Are you interested
What amount of time do you plan to devote to the business?
Income expectations
Company
Address
Date Started
Position
Monthly Income
Company
Address
From
to
Position
Monthly Income
When you find the perfect business, how much money are you prepared to invest?
Where will the funding come from to pay for the franchise opportunity? (Be specific)
Please enter whole numbers without decimals,
Salary
Bonus/Commissions
Dividends
Real Estate Income
Other Income
Total Yearly Income
$
Income Notes
Please enter whole numbers without decimals, or currency symbols.
Total Assets $
Total Liabilities $
Do you plan to borrow against property you own?
Amount of Equity?
Select and rank 4 categories that are of the most interest to you and tell us why. Also, please select any categories that are of no interest of all.
Automotive
Why?
Computer Tech
Why?
Maintenance
Why?
Hair Styling
Why?
Employment & Personnel
Why?
Maid Service & Cleaning
Why?
Retail Sales
Why?
Coffee
Why?
Laundry & Dry Cleaning
Why?
Repair/Restoration/Decorating
Why?
Child Education
Why?
Health, Beauty & Nutrition
Why?
Printing & Copying
Why?
Sports
Why?
Food-Related Businesses
Why?
Packaging & Mailing
Why?
Building, Storage
Why?
Financial Services
Why?
Management & Training
Why?
Misc. & Unique
Why?
Energy
Why?
Signs
Why?
Other
Why?
Do you know anyone else who would benefit from the services offered by Peerless Franchises, LLC?
May we contact them?
Name
Select the corresponding description that best represents the closest match in each category.
Less than $20,000
$20,000-$30,000
$30,000-$50,000
$50,000-$100,000
Above $100,000
Less than $50,000
$50,000-$100,000
$100,000-$250,000
$250,000-$500,000
Above $500,000
Under $100,000
$100,000-$200,000
$200,000-$500,000
Above $500,000
Home-Based
Virtual Office
Business Space
Retail Space
Industrial Space
Under $40,000
$40,000-$60,000
$60,000-$100,000
Above $100,000
Single Unit/Territory
Multiple Locations/Territories
No employees
1-3 Employees
3-10 Employees
Over 10 Employees
Less than $500 per month
$500 to $3,000 per month
$3,000-$7,000 per month
Above $7,000 per month
No inventory
Less than $3,000 on hand
$5,000-$25,000 on hand
Above $25,000 on hand
No Set Hours
9 a.m. to 5 p.m.
6 a.m. to 10 p.m.
24 Hours
No Set Schedule
Open 5 Days Per Week
Open 6 Days Per Week
Open 7 Days Per Week
Professional Level (Direct Sales, Consulting)
Management Level (Organizational Management)
Craftsman Level (Significant Training, Possible License Required)
Entry Level (Hourly Employee)
Not Important
Limited Brand Name
Regional Brand Name
National Brand Name
No Support Wanted
Minimal Support as Needed
Direct Interactive Support
Quarterly Hands-On Support
Part-Time
Passive
Active Individual
Active Family
Multiple Owners
Immediate
1-3 Months
3-6 Months
6-12 Months
More Than 1 Year
Traditional Business Model
Unique Business Model (Niche Industry)
Next Generation Business Model (Trend Setting)
Retail Shop or Food Industry
Service (Provide skilled services to the general public)
Home-Based
Business-to-Business (Products/Services exclusively to businesses)
Passive/Absentee (Investment return is most important characteristic)
