Full name *

Age *

Spouse name

Home Address *

City *

Province / State *

Postal / Zip code *

Work / Day phone *

Home / Evening phone *

Fax

Best time to call *

Number of children / dependents *

Self ExcellentGoodFairOther

Spouse ExcellentGoodFairOther

Self SelfSpouse

Driver’s License # *

License Class *

Hazardous Materials Certified? * YesNo

License ever cancelled / suspended? * YesNo

If license cancelled / suspended explain why *

Name*

Address / Phone*

Years Known*

Name*

Address / Phone*

Years Known*

Name*

Address / Phone*

Years Known*

Are you Self-Employed? * YesNo

(If yes, explain – please include all relevant information about your business)

Have you ever had a business failure? * YesNo

(If yes, explain)

Current / Most Recent Firm *

Address *

City *

Province / State *

Present / Most Recent Salary *

Starting Year *

Work Description *

Current / Most Recent Firm *

Address *

City *

Province / State *

Present / Most Recent Salary *

Starting Year *

Work Description *

Date Employed *

From Date *

To Date *

Position *

Company Name *

Type of Business *

Address *

City *

Province / State *

Name of Supervisor *

Responsibilities *

Reason for Leaving *

Salary, Wages *

Bonus, Commissions *

Dividends, Interest *

Real Estate Income *

Business Profits *

Note, Account Receivable *

Other Income (Specify Kind) *

Total Per Annum *

Cash on Hand – Bank *

Real Estate *

Vested Profit Share *

Securities *

Bonds / Debentures *

Notes / Mort. Rec. *

Other (Specify Kind) *

Total Assets *

Notes, Loans, Payable – Bank *

Notes, Loans, Payable – Friends *

Notes, Loans, Payable – Relatives *

Accounts & Bills Due *

Real Estate Mortgages *

Other Debts (specify) *

Total Liabilities *

Net Worth *

Total Liabilities & Net Worth

Funds Available for Investment in This Business *

If additional funds are required for this business, are they available to you? * YesNo

If so, explain

Do you plan to have a partner? * YesNo

If so, will the partner be active? YesNo

Please give us the partner's information

Do you plan to have investors? * YesNo

If so, to what extent?

Do you plan to have your partner (and/or investors) own (and/or contribute to) more than 10% of the business? YesNo
If so, please copy this link to each of them and have each of them fill out this form.

Name *

Address / Phone *

Highest Credit *

Purpose *

Name *

Address / Phone *

Highest Credit *

Purpose *

Name *

Address / Phone *

Highest Credit *

Purpose *

How did you become interested in Goodbye Graffiti? Inc.? *

From what source did you hear about us? *

Which territories are you interested in? *

When did you want to open a franchise? *

Have you ever been involved in the graffiti removal or power washing industry before? * YesNo

If yes, which company/companies?

What are your reasons for starting your own business? *

What are some questions you have concerning owning your own business? *

Complete the following in your own words:
"As I consider my experience and abilities, I am confident that I can successfully operate a Goodbye Graffiti? Inc. franchise because..." *

Further comments/questions

I agreeI do not agree

Current E-mail Address