Car-X - Confidential Qualification Form

Car-X Confidential Qualification Sheet
Please contact us at 1-800-359-2359 or use the Email form below.

Please provide sufficient information so that our client coordinator may assure a prompt and helpful response. Thank you.

(Areas marked with an asterisk (*) are required)

First Name

Last Name

Address

City

State

Zip Code

Telephone

Alternate Telephone

Your Email

Your Date of Birth

If Married, Spouse's Name

Number of Dependents

Company 1 (Name, Address, Your Position)

Company 2 (Name, Address, Your Position)

Company 3 (Name, Address, Your Position)

Education (furthest level completed)

Total Assets (Include all Bank Accounts, Real Estate..)

Are Your Assets in a Trust?

Total Liabilities (Include all Personal and Business)

Markets of Interest (In Order, Separated by Commas)

If You are Willing to Relocate, Please State Where

What Prompted Your Inquiry?

If You Know A Car-X Affiliate, Please State Their Name

If You've Ever Owned a Business, List It

If You Have Financial Interests in Other Businesses, List Them Here

Are you a Defendant in Any Legal Suits or Actions?

If You've Ever Been Convicted of a Crime, List It

Have You Filed Bankruptcy in the Last 7 Years?

Is Your Financial Position Adequate to Franchise a Shop?

Please List 3 Business and 3 Character References

Please List All Relevant Personal and Business Banks

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