First Name
*
Last Name
*
Street Address
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City
*
State
*
Zip
*
Phone Number
*
E-mail
*
Business Interest
Check below the businesses you have considered when thinking about your future.
Business Interest
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Childare
Automotive
Fitness Center
Dentist
Pet Service
Senior Care
Car Wash
Retail
Restaurants/Bars
Service Businesses
Car Dealerships
Freight
Business Services
Distribution
Manufacturing
Home Services
Warehousing
Other business interest
Areas Of Special Interest
This section is devoted to those areas of interest that are significant to you: in particular, Hobbies, Sports, Leisure Activities, Travel, Gardening etc. Indicate your special interests below or use a separate sheet
Special Interest
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Self Estimates
Listed below are areas where you can rate your level of skill and comfort on a scale of 1 – 10 with 10 being the highest, 5 being average and 1 being low.
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1
2
3
4
5
6
7
8
9
10
Mechanical Ability
Manual Skills
Scientific Ability
Math Ability
Artistic Ability
Musical Ability
Teaching Ability
Friendliness
Sales Ability
Managerial Skills
Clerical Ability
Office Skills
Specific Skills and Knowledge
We all have more skill, knowledge and comfort in some areas as compared to others. Listed below are specific areas where you can rate your level of skill and comfort on a scale of 1 – 10 with 10 being the highest level of your skill, knowledge or comfort.
Accounting
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Finance
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Taxes
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Sales
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Marketing
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Sales Mgmt
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Managerial
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Motivational
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Analytical
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Verbal
*
Writing
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Mechanical
*
Computer
*
Design
*
Programming
*
Systems
*
Controls
*
Concepts
*
Manual
*
Lifestyle and Financial Requirements
The right business must fit your lifestyle and financial needs. Please complete the following section.
Time distance of business from your home
*
Are you willing to move for the right business?
*
Please Select
Yes
No
Earliest starting time desired
*
Latest quit time acceptable
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Minimum take home compensation (Start) required per month
*
Is the opportunity for family members to participate in the business important?
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Please Select
Yes
No
Participation in the business to be:
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Full Time
Part Time
Absentee
Activity level desired:
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High
Medium
Low
Prefer work environment to be:
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Inside
Outside
Both
Doesn't Matter
Travel:
*
Prefer Travel
Some travel ok
Prefer no travel
Overnight Travel:
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Ok
Sometimes
None
Customer contact:
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High
Medium
Low
None
Financial Information
Purchase Timeframe
*
How long have you been searching?
*
*
From
To
Preferred Price Range of Business
Preferred Initial Investment
Total Available for Down Payment
*
Income Required (Monthly)
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Cash on hand
*
Total Assets
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Total Liabilities
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Total Income
*
Your net worth $
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Current Occupation
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Educational Background
Please summarize your educational background including special interest courses.
*
Please include your resume here (optional)
Business Experience
Please summarize your work experience including any information that would be helpful in identifying your ideal business.
*
Thank you!
Signature *Use your mouse/finger to sign
*
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