Pre Qualification Form

Date of Application*
Date Format: MM slash DD slash YYYY

Date of Application*

Personal Information
Personal Information
- First Name*
  First Name*
- Middle Name
  Middle Name
- Last Name*
  Last Name*
- Date of Birth
  Date Format: MM slash DD slash YYYY
  
  Date of Birth
- Age*
  Age*
- Gender*
  Gender*
- Mobile No.*
  Mobile No*
- Telephone No.
  Telephone No.
- Email Address*
  
  Email Address*
- Marital Status*
  - Single
  - Married
  - Divorced
- Current Address*
  Current Address*
- Zip Code*
  Zip Code*
- Years of Residence*
  Years of Residence*
- Provisional Address
- Previous Address
- Other Address
  - Provisional Address
  - Previous Address
- Zip Code
  Zip Code
- Years of Residence
  Years of Residence
- Full Name of Spouse
  Full Name of Spouse(if applicable)
- Age
  Age
- Occupation
  Occupation
- Name and Age of Dependent / Independent Children or Other Dependents
  Name and Age of Dependent / Independent Children or Other Dependents
- Are you retired US military?
  Are you retired US military?
  - Yes
  - no
- If yes, please indicate years of service:
  If yes, please indicate years of service:

General Business Interest
General Business Interest
- *Why are you interested in opening a LaundroLab?*
  *Why are you interested in opening a LaundroLab?
- *How do you plan on funding the business opportunity?*
  *How do you plan on funding the business opportunity?
- Which area are you interested in opening a LaundroLab?*
  *Which area are you interested in opening a LaundroLab?
- Will the LaundroLab be owned and operated by yourself or a group?*
  *Will the LaundroLab be owned and operated by yourself or a group?

- Business Experience
  - I have previously owned my own business
  - I have never owned my own business
- Type of Business:
  Type of Business:
- Trade Name or Company Name:
  Trade Name or Company Name:
- Address:
  Address:
- Position/Title/Duties
  Position/Title/Duties
- Percentage of Ownership/Capitalization
  Percentage of Ownership/Capitalization
- Dates of Business Establishment (Indicate from-to-period)
  Dates of Business Establishment (Indicate from-to-period)
- Status of Business:
  Status of Business:
  - Operational/Active
  - Closed/Inactive
- Business Status
- If closed/inactive, state the reason why:
  If closed/inactive, state the reason why:

- How long have you been looking for a business?*
  *How long have you been looking for a business?
- What other businesses have you investigated?*
  *What other businesses have you investigated?
- Are you seeking a single franchise or multiple?*
  *Are you seeking a single franchise or multiple?
- When would you like your franchise to open?*
  *When would you like your franchise to open?
- Would your involvement in the business be full time or part time?*
  *Would your involvement in the business be full time or part time?
- What attracts you to owning your own business?*
  *What attracts you to owning your own business?
- What have you liked most and least about past jobs?*
  *What have you liked most and least about past jobs?
- What are your strengths and weaknesses relating to managing a business?*
  *What are your strengths and weaknesses relating to managing a business?
- What are your major questions or concerns about business ownership?*
  *What are your major questions or concerns about business ownership?
- What do you forsee your role in the business being?*
  *What do you forsee your role in the business being?
- What else should we know about you?*
  *What else should we know about you?

Employment Experience (if applicable)
Employment Experience (if applicable)
- Name of Employer:
  Name of Employer:
- Address:
  Address:
- Position/Title/Duties:
  Position/Title/Duties:
- Dates of Employment (indicate from-to-period):
  Dates of Employment (indicate from-to-period):
- Person Reporting Directly To/Title:
  Person Reporting Directly To/Title:
- If employed from the past, state reason for separation:
  If employed from the past, state reason for separation:
- Starting Salary:
  Starting Salary:
- Ending Salary:
  Ending Salary:

Educational Background
Educational Background

- Name of School
  Name of School
- School Two
- Dates of Attendance
  Dates of Attendance
- Dates of Attendance Two
- Course/Major
  Course/Major
- Course/Major Two
- Graduation Date
  Graduation Date
- Graduation Date Two

Sources of Income
Sources of Income

- - Assets
- - Salary*
    *Salary
  - Bonus & Commission*
    *Bonus & Commission
- - Dividends & Interest*
    *Dividends & Interest
- - Net Real Estate Income*
    *Net Real Estate Income
- - Retirement Income*
    *Retirement Income
- - Other Income*
    *Other Income
- - Cash on Hand & in Banks*
    *Cash on Hand & in Banks
- - Cash Value of Life Insurance*
    *Cash Value of Life Insurance
- - Public Stocks & Bonds*
    *Public Stocks & Bonds
- - Reitrement Accounts & IRAs*
    *Reitrement Accounts & IRAs
- - Real Estate*
    *Real Estate
- - Autos, Boats, RVs, etc.
    *Autos, Boats, RVs, etc.
- - Loans to Individuals*
    *Loans to Individuals
- - Loans to Businesses*
    *Loans to Businesses
- - Net Worth of Businesses Owned*
    *Net Worth of Businesses Owned
- - Other Assets
  - Asset One
  - Asset Two
  - Asset Three
  - Asset Four
- - Total Assets:
    Total Assets:
- - Liabilities
- - Credit Cards & Line of Credits*
    *Credit Cards & Line of Credits
- - Life Insurance Policy Loans*
    *Life Insurance Policy Loans
- - Margin Accounts*
    *Margin Accounts
- - Unpaid Taxes & Interest*
    *Unpaid Taxes & Interest
- - Mortgage(s) & HELOC*
    *Mortgage(s) & HELOC
- - Loans for Autos, Boats, RVs, etc.
    *Loans for Autos, Boats, RVs, etc.
- - Loans from Individuals*
    Loans from Individuals
- - Loans from Businesses*
    *Loans from Businesses
- - Other Liabilities
  - Liability One
  - Liability Two
  - Liability Three
  - Liability Four
- - Total Liabilities
    Total Liabilities
- Net Worth (Total Assets - Total Liabilities)
- Net Worth

Contingencies
Contingencies
- Do you have any contingent liabilities?*
  *Do you have any contingent liabilities?
  - Yes
  - No
- If so, please explain
  If so, please explain
- Have you ever filed for bankruptcy?*
  *Have you ever filed for bankruptcy?
  - Yes
  - No
- If so, please explain
  If so, please explain
- Have you or your spouse ever been convicted of a crime?*
  *Have you or your spouse ever been convicted of a crime?
  - Yes
  - No
- If so, please explain
  If so, please explain
- Are you or your spouse currently under any type of criminal investigation?*
  *Are you or your spouse currently under any type of criminal investigation?
  - Yes
  - No
- If so, please explain
  If so, please explain
- Are you or your spouse currently involved in any pending lawsuits?*
  *Are you or your spouse currently involved in any pending lawsuits?
  - Yes
  - No
- If so, please explain
  If so, please explain
- Are you or your spouse subject to any civil judgements?*
  *Are you or your spouse subject to any civil judgements?
  - Yes
  - No
- If so, please explain
  If so, please explain

In submitting the foregoing statement, the undersigned guarentees its accuracy with the intent that it be relled upon granting a franchise and extending credit to the undersigned and warrents that they have not knowingly withheld and information that might affect their credit risk.

Also, the undersigned expressly agrees to immediately notify the franchisor or its agents in writing of any material change in their financial condition - whether an application for furthher credit is made or not. In the absence of such written notice, it is ecpresssly agreed that the franchisor or its agents in granting a franchise or credit may rely on this statement as having the same force and effect; as if delivered upon the date additional credit is requested or existing credit is extended or continued/.

The undersigned certifies that each part of the application and financial statements hereof and the information inserted herein has been carefully read and is true and correct.
Agree For Statements*
- I agree to all the above statements
- Date:
  Date:
  Date Format: MM slash DD slash YYYY
- Print Name:
  Print Name:

Confidential Franchise Pre-Qualification Form

Personal Information

Personal Information

General Business Interest

General Business Interest

Employment Experience (if applicable)

Employment Experience (if applicable)

Educational Background

Educational Background

Sources of Income

Sources of Income

Assets

Other Assets

Liabilities

Other Liabilities

Net Worth (Total Assets - Total Liabilities)

Contingencies

Contingencies