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First Name*

Last Name*

Spouse/Partner's First Name

Spouse/Partner's Last Name

E-Mail*

Phone

Address*

City

State

Zipcode

Country

Your Resume

Your Photo (Optional)

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?YesNo

Any other source of income?

Total Combined Income

Have you ever owned your own business?YesNo

What type of business?

How long have you or the company been in business?

How did you become interested in this business?*

When you would like to open?*

What's 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?*

ASSETS:

Basic financial asset information

Cash on Hand & In Banks

Stocks, Bonds & Securities

Loans owed to you (Due w/in 1 yr)

Real Estate: (present value)

Businesses Owned

Any other assets

LIABILITIES:

Basic liability information

Notes payable to bank

Notes payable to individuals

Total credit card debt

Vehicle Loans

Home Mortgage

Other Mortgages

Student Loans

Any other debts

NET WORTH:

Assets minus Liabilities

Total Assets

Total Liabilities

Assets - Liabilities = Net Worth

Amount Available to Invest*Less Than $50,000$50,000 To $150,000$150,000 To $300,000$300,000+

Source of Capital*

Date

Closing

I AGREE TO THE TERMS OF THE A N GLOBAL FRANCHISE GROUP PRIVACY POLICY AND OPT-IN TO ALLOW THE BUSINESS USE OF THE ABOVE PROVIDED DATA.