Step 3 of 11:
BUSINESS INFORMATION
Do you currently have an ownership interest in a business? If so, complete the section below. Otherwise, proceed to the next step.
Business Name & Address
Step 6 of 11:
FINANCIAL INFORMATION
To complete this section, gather any relevant documentation for your financial assets
ASSETS
Step 7 of 11:
FINANCIAL INFORMATION
To complete this section, gather any relevant documentation for your financial liabilities.
LIABILITIES
Review Information
Please review your information before completing the application.
- First Name:
- Last Name:
- Email:
- Confirm Email:
- Franchise Interested In:
- Primary Phone Number:
- Work Phone Number:
- Cell Phone Number:
- Fax Phone Number:
- Street Address 1:
- Street Address 2:
- City:
- State:
- Zip:
- Spouse Full Name:
- Spouse/Partner Email:
- Spouse/Partner Cell:
- Best time to call:
- Business Name:
- Street Address 1:
- Street Address 2:
- City:
- What are the three greatest challenges facing your business?:
-
- accomplishment?:
- disappointment?:
- encourages you the most?:
- cautions you the most?:
- Please organize the following aspects of your life in the order of most importance to you:
-
- Please keep me updated by email:
- Residence:
- Marital Status:
- Number of Children:
- Full Legal Name as it appears on identification:
- Are you a U.S. or Canadian Citizen or do you have the right to legally reside (and work) in the U.S. or Canada for the duration of the franchise agreement?:
- Are you a U.S. or Canadian military veteran?:
- Have you ever been convicted or charged of a misdemeanor (other than a traffic violation)?:
- Have you ever been convicted of or charged with a felony?:
- Have you ever been convicted or charged of DWI or DUI?:
- Do you have any existing or pending tax liens?:
- Have you ever filed or have any pending or discharged bankruptcy (personal or business)?:
- Do you have any pending civil litigation (personal or business) and/or have you ever filed or had any filed against you?:
- Total Capital Available for Investment:
- Cash on hand in bank:
- Primary residence:
- Commercial real estate:
- Other real estate:
- Business Value:
- Automobiles:
- Personal Property:
- Marketable Securities:
- Notes receivable:
- Retirement Fund:
- Profit Sharing:
- 401(k):
- IRA:
- Name:
- Value:
- Name:
- Value:
- Name:
- Value:
- Yearly Income:
- Spouse Income:
Your Summary:
- Total Assets:
- Total Assets:
- Total Assets:
- Total Liabilities:
- Mortgage:
- Second Mortgage:
- Lines of credit:
- Business loans:
- Credit cards:
- Vehicle loans:
- School loans:
- Name:
- Value:
- Name:
- Value:
- Name:
- Value:
- Name:
- Value:
- Name:
- Value:
- Name:
- Value:
- Name:
- Value:
Your Summary:
- Total Assets:
- Total Assets:
- Total Assets:
- Total Liabilities:
- Employer Name:
- Address 1:
- Address 2:
- City:
- State:
- Zip:
- Start Date:
- End Date:
- Salary:
- Position:
- Reason for leaving:
- Employer Name:
- Address 1:
- Address 2:
- City:
- State:
- Zip:
- Start date:
- End date:
- Salary:
- Position:
- Reason for Leaving:
- Highest Education Level:
- College / University:
- Major:
- Years Attended:
- Degree:
- Reference Name:
- Reference Phone:
- Best time to contact:
- Reference Name:
- Reference Phone:
- Best time to contact:
- Reference Name:
- Reference Phone:
- Best time to contact:
- When would you be available to visit Neighborly® corporate headquarters?:
- When would you be available to start your franchise?:
- What are your preferred locations? (be specific):
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