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)

Some High SchoolHigh SchoolSome CollegeCollege GraduateGrad School
Total Assets (Include all Bank Accounts, Real Estate..)*
Are Your Assets in a Trust?

YesNo
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?*

YesNo
If You've Ever Been Convicted of a Crime, List It
Have You Filed Bankruptcy in the Last 7 Years?*

YesNo
Is Your Financial Position Adequate to Franchise a Shop? *

YesNo
Please List 3 Business and 3 Character References*
Please List All Relevant Personal and Business Banks*
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