• First Name*
• Last Name*
• Email Address*
• Your Age
• Spouse or Partner's Name
• Age
• Number of Dependents

• Primary Number*
• Alternate Number
• Best Time To Call
• Address*
• City*
• State*
• Zip*

• Please Choose Employed Self Employed May be Laid Off Not Working Your Employment Status
• Your Current or Former Employer
• Your Title
• Your Compensation
• Please Choose Employed Self Employed May be Laid Off Not Working Spouse or Partner's Employment Status
• Spouse or Partner's Current or Former Employer
• Spouse or Partner's Title
• Spouse or Partner's Compensation

• Have you owned a business? Please Describe
• Please Choose No Don't remember Name James d’Auguste John d’Auguste Jerry Pollio Sarah Morgan Jennifer Palm Tom Raymond Tamyra Wallace Are you currently working with a specific Executive Franchise Specialist?
• Please Choose Yes No Have you ever worked with another consultant?
• Which businesses have you investigated?
• First Choice for Business Location
• Second Choice for Business Location

  Reason for Buying a Business (select all that apply)

• New Career Direction
• Diversify Portfolio
• Lifetime Goal
• Second Career
• Build Wealth
• Lifestyle Change
• Too young to retire
• Work with partner
• Other

 

 

• Please Choose Sole Proprietorship Single Unit Multiple Units Area Developer Regional Developer Master Licensee Type of Business
• Why do you want to buy a business?
• What do you like most and least about your work experience?

 

  Which areas are your strengths? (select all that apply)*

 

• Managerial
• Sales
• Marketing
• Finance
• Operations
• Technology
• Customer Service
• Personnel Management
• Consulting
• Program Management
• Other

 

 

• Please Choose Exceptional High Medium Low No Experience Rate Your Sales Skills
• Please Choose Exceptional High Medium Low No Ability Rate Your Managerial Ability
• Please Choose Exceptional High Medium Low No Passion Rate your Passion for Success

 

• List Hobbies and Areas of Interest

 

• Complete the following, in a perfect world my new business...

 

  Markets that Appeal to You (select all that apply)

 

• Advertising
• Automotive
• Business Service
• Coaching
• Consulting
• Children Education
• Design and Decorating
• Fitness
• Financial Services
• Food/Restaurants
• Health
• Home Improvement
• Handyman Services
• Lodging
• Maintenance
• Marketing
• Medical
• Personal Care
• Postal Centers
• Printing
• Pets
• Recreation
• Consumer Service
• Senior Care
• Sign Companies
• Technology
• Training

• Cash
• Stocks and Bonds
• 401k an IRA
• Primary Residence Value
• Other Real Estate
• Autos
• Other Assets
• Total of above*

• Notes payable
• Credit Card Balances
• Primary Residence Mortgage
• Other Real Estate Debt
• Auto Loans
• Other Debt
• Total of above*

• Bonuses/commissions
• Real Estate Income
• Dividends/interest
• Other
• Total of above*

• Please Choose Less than $20,000 Less than $50,000 Less than $75,000 Less than $100,000 Less than $200,000 $200,000-$500,000 0ver $500,000 Cash Investment
• Please Choose Less than $75,000 Less than $100,000 Less than $150,000 Less than $200,000 Less than $500,000 Less than $1,000,000 0ver $1,000,000 Total Investment

 

  I would like to explore these financing options (select all that apply)

 

• Signature Loan
• Commercial Bank Loan
• Leasing Options
• Home Equity
• 401k, with no withdrawal penalty
• SBA

 

 

• Please Choose Immediately 1 to 3 Months 3 to 6 Months 6 to 9 Months More Than 9 Months How Soon Would You Like to Start Your New Business?
• Please Choose Yes No Not Sure Yet Do you plan on having a partner?
• Please Choose Yes No Not Sure Yet Do you plan on having an investor?

• Please Choose Yes No Have you or your spouse ever been involved in a bankruptcy?*
• Please Choose Yes No Do you or your spouse have any judgments, liens or lawsuits pending?*
• Please Choose Yes No Have you or your spouse ever been convicted of a felony?*