Contact Name First*Last*Spouse/Partner Name FirstLastAddress(required) Street Address*Address Line 2City*State / Province /RegionPostal / Zip Code*Country*How long have you lived at this address?Cell NumberOther NumberEmail* Spouse/Partner Email Citizenship StatusDependents List all dependents as represented on your tax filingsName FirstLastAgeName FirstLastAgeName FirstLastAgeUpload Resume/CV (Optional) Upload Photo (Optional) FileFileBusiness Background Tell us a little about your business experience Present EmployerTitleResponsibilitiesLength of EmploymentAnnual SalaryWill you be leaving this employment to open your business?Any other source of income?Total Combined IncomeHave you ever owned your own business?What type of business?How long operatedHow did you become interested in this business?*Have you ever managed employeesIf so, at what capacity?When would you like open?*Whats your primary reason(s) for going into your own business?*What would you consider your strengths in owning your own business?*What would you consider your primary concerns in owning your own business?*In which geographical area would you like to open your business?*Will you be opening this business with a partner?If so, will this partner be active?What languages do you speak?Financial Information Assets: Basic financial asset information Cash on Hand & In BanksStocks, Bonds & SecuritiesRetirement FundsLoans owed to you (Due w/in 1 yr)Do You Own or Rent Your Home?Real Estate: (present value)Businesses OwnedAny other assetsLiabilities: Basic liability infomation: Notes payable to bankNotes payable to individualsTotal credit card debtVehicle LoansHome MortgageOther MortgageStudent LoansAny other debtsNet Worth: Assets minus Liabilities Total AssetsTotal LiabilitiesAssets - Liabilities = Net WorthAmount of Capital to Invest*Source of Capital*Closing This is not a contractual agreement. The completion of this document does not obligate you in any way to purchase a Lice Lifters Franchise. The undersigned certifies that the information supplied is true and correct.