Request for Consideration

Franchise Request for Consideration

First and Last Name:

Home Phone:

Cell Phone:

Email:

Fax:

Other Phone:

Street Address:

City/State/Zip

Date of Birth:

Education:

Do You Own or Rent?

Own

Rent

How long at this address?

Current Occupation:

How long at this occupation?

Have you ever been convicted of a felony offense?

Marital Status:

If married, will your spouse participate in the business?

Yes

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Spouse/Partner Information

First and Last Name:

Email Address:

Current Occupation:

How long at this occupation?

Annual Income:

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Business Experience/Employment History

From - To (years)

Company/City

Position:

Annual Income:

From - To (Years):

Company/City

Position:

Annual Income:

From - To (Years):

Company/City:

Position

Annual Income:

From - To (Years):

Company/City:

Position:

Annual Income:

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Business/Management Goals & Objectives

Is your objective to be:

Actively Involved?

Manager?

Owner?

Specify the cities or areas and state you are interested in:

How long have you been looking at business opportunities?

What other types of businesses are you considering?

How did you hear about PuparazziMobile?

What specifically about the Puparazzi Program appeals to you?

On a scale of 1 - 10, with 10 being the highest, how committed are you to owning your own business?

What is your timeline for starting your own business? (In months):

Why do you believe you can successfully operate and manage an Puparazzi Mobile Program?

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Financial Disclosure

Assets

Cash in Checking Account:

Cash in Savings Account:

Real Estate (Home Value):

Other Real Estate: $

Cash Surrender in Life Insurance: $

Qualified Plan Assets:

New Field:

IRA Assets: $

Other Assets: $

New Field:

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Liabilities

Other Liabilities: $

Notes Payable to Banks: $

Notes Payable to Finance Companies: $

Real Estate Mortgage Indebtedness: $

Credit Cards: $

Total Liabilities: $

NET Worth:

What amount of money do you feel comfortable investing?

What is your liquid capital?

Have you ever filed for bankruptcy?

Yes

On a scale of 1 - 10, with 10 being the highest, how committed are you to moving forward with Puparazzi Mobile LLC?

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By typing your name down below, this will serve as your digital signature for this document.

Signature:

Date:

Franchise Request for Consideration

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