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Note:
Please answer
all
questions on this form.
Personal Information
Name:
Address:
Apt/Suite:
City:
State:
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Oregon
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip code:
Home Phone:
Business Phone:
Cell Phone:
E-mail:
Best time to call:
Please Select
Morning
Afternoon
Evening
Best Phone :
Please Select
Home Phone
Business Phone
Cell Phone
Your occupation / title:
Are you currently employed:
Please Select
Yes
No
Date of birth:
Are you a U.S. Citizen?
Please Select
Yes
No
Marital status:
Please Select
Single
Married
Divorced
Widowed
If married, spouse's name and occupation:
Highest level of education completed:
Please Select
High School
College
Graduate School
General Information
If job search web site, which web site?
If newspaper ad, which newspaper?
Have you ever owned a business?
Please Select
Yes
No
If "yes," what type of business?
Why are you seeking a new business at this time?
When do you plan to start your new business?
How long have you been looking for a business?
Will you have partners (other than spouse)?
What other businesses have you looked at?
Which businesses, if any, are you still considering?
What are your your preferred geographic areas?
What factor is most important in selecting a new business?
If we can identify a business that meets your needs, will you be ready to move forward within a reasonable period of time?
Please Select
Yes
No
Not Sure
What are your hobbies and personal interests?
What professional organizations do you belong to?
Do you prefer managing employees or working alone?
Please Select
Managing Employees
Working Alone
Either/Both
What sort of work environment do you prefer?
Please Select
Traditional/Formal
Business Casual
Very Informal
Are there any business categories you want to totally avoid?
Are you fully committed to owning a business, or are you also applying for jobs at this point?
Please Select
Fully Committed
Also Applying For Jobs
Not Sure
Rate your motivation/desire/commitment to have your own business, 1 through 10 (10 being the highest):
Please Select
1
2
3
4
5
6
7
8
9
10
How would you rate your ability/interest in sales?
Please Select
Very Low
Low
Average
High
Very High
Business Categories and Industries
What business categories/industries are you most interested in?
Advertising/Marketing
Automotive
Building, Contracting & Storage
Child Education & Development
Coffee/Cafe
Commercial Building Maintenance
Computer Technology
Convenience Stores & Newsstands
Dry Cleaning
Financial Services
Hairstyling Salons
Health, Beauty & Nutrition
Home Design & Furnishings
Home Repair & Restoration
Hotels/Motels
Mailboxes, Packing & Shipping
Pet Care
Printing & Copying
Real Estate Services
Recruiting & Employment
Residential Cleaning
Restaurant & Food Service
Retail Stores
Senior Care
Signs & Display Graphics
Sports
Training & Management Consulting
Other
If you selected "other," please specify:
Financial Information
How much liquid capital do you have for the business?
Please Select
Less than $25,000
$25,000 to $50,000
$50,000 to $75,000
$75,000 to $100,000
More than $100,000
How much are you prepared to invest in your new business (total), including borrowed funds?
Please Select
Less than $25,000
$25,000 to $50,000
$50,000 to $75,000
$75,000 to $100,000
$100,000 to $150,000
$150,000 to $250,000
$250,000 to $350,000
$350,000 to $500,000
$500,000 to $750,000
$750,000 to $1 Million
More than $1 Million
Do you have the financial means to carry you through a reasonable "ramping-up" period?
Please Select
Yes
No
Not Sure
What is your net worth? (Assets - Liabilities)
Please Select
Less than $100,000
$100,000 to $250,000
$250,000 to $500,000
$500,000 to $750,000
$750,000 to $1 million
More than $1 million
What will be the source of your investment capital?
Please Select
Savings
Family
Bank Loan
Home Equity
Credit Card
IRA/401k
Stocks
Severance
Other
Do you have other sources of income?
Please Select
Yes
No
If you selected "yes," please explain:
What will your personal net income expectations be from your new business, after:
1 Year:
Please Select
Less than $25,000
$25,000 to $50,000
$50,000 to $75,000
$75,000 to $100,000
$100,000 to $150,000
$150,000 to $200,000
$200,000 to $250,000
More than $250,000
Don't Know
2 Years:
Please Select
Less than $25,000
$25,000 to $50,000
$50,000 to $75,000
$75,000 to $100,000
$100,000 to $150,000
$150,000 to $200,000
$200,000 to $250,000
More than $250,000
Don't Know
3 Years:
Please Select
Less than $25,000
$25,000 to $50,000
$50,000 to $75,000
$75,000 to $100,000
$100,000 to $150,000
$150,000 to $200,000
$200,000 to $250,000
More than $250,000
Don't Know
Business Format
Please select the option(s) below that are most appealing and appropriate for you:
Single Unit (owner-operator of one location)
Multi-Unit (own and manage several locations of the same franchise)
Master Franchisee or Area Development (own a larger region and manage/mentor other franchisees on your team at multiple locations)
Storefront (bricks-and-mortar retail locations)
Mobile Business (travel to the customer in an equipped van to provide your product or service)
Business-to-Business Service (provide professional services to other businesses, as opposed to consumers)
Home-Based Business (operate from home as an independent representative of your product or service)
Semi-Absentee (passive ownership, where you oversee the business only part-time)
Don't' Know
Working Hours
Please indicate the weekly hours you are willing/able to dedicate to your new business:
Part-time (less than 20 hours per week)
3/4-time (20 to 40 hours per week)
Full-time (40+ hours per week)
Whatever number of hours it takes to be successful
Smart Choice Franchises Corp.
1079 Old Ford Rd
Huntingdon Valley, PA 19006
Phone: 1-886-SMART-55 • Fax: 215-895-9516
