Lice Lifters
Franchise Opportunities

Contact Name
First*
Last*
Spouse/Partner Name
First
Last
Address(required)
Street Address*
Address Line 2
City*
State / Province /Region
Postal / Zip Code*
Country*
How long have you lived at this address?
Cell Number
Other Number
Email*
Spouse/Partner Email
Citizenship Status
Dependents

List all dependents as represented on your tax filings
First Name
Last
Age
First Name
Last
Age
First Name
Last
Age
Upload Resume/CV (Optional)
Upload Photo (Optional)
Choose File
Choose File
Business Background

Tell us a little about your business experience
Present Employer
Title
Responsibilities
Length of Employment
Annual Salary
Will you be leaving this employment to open your business?
Any other source of income?
Total Combined Income
Have you ever owned your own business?
What type of business?
How long operated
How did you become interested in this business?*
Have you ever managed employees
If 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 Banks
Stocks, Bonds & Securities
Retirement Funds
Loans owed to you (Due w/in 1 yr)
Do You Own or Rent Your Home?
Real Estate: (present value)
Businesses Owned
Any other assets
Liabilities:

Basic liability infomation:
Notes payable to bank
Notes payable to individuals
Total credit card debt
Vehicle Loans
Home Mortgage
Other Mortgage
Student Loans
Any other debts
Net Worth:

Assets minus Liabilities
Total Assets
Total Liabilities
Assets - Liabilities = Net Worth
Amount 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.
Name
This field is for validation purposes and should be left unchanged.