Lead Qualification Details

Lead Qualification Details

Lead Qualification Details


Fields marked with * are mandatory.


Personal Information
First Name : Last Name : Date : Email : Gender : MaleFemale US Citizen : YesNo Present Address : Work Phone : Home Phone : Home Phone Extension : Country : Work Phone Extension : City : How long at this address? (Yrs) : State / Province : *Zip / Postal Code : Country : Previous Address : City : Birth Date : State / Province : Zip / Postal Code : Marital Status : SingleMarried Best Time To Call : Home Ownership : OwnRenting Spouse US Citizen : YesNo Spouse Name : Spouse Social Security # : Spouse Birth Date :


Assets and Liabilities
ASSETS LIABILITIES Cash on Hand & in Banks ($) : Mortgages ($) : Marketable Securities ($) : Accounts Payable ($) : Accounts / Notes Receivable ($) : Notes Payable ($) : Retirement Plans ($) : Loans On Life Insurance ($) : Real Estate ($) : Credit Cards (total balance) ($) : Personal Property ($) : Unpaid Taxes ($) : Business Holdings ($) : Other Liabilities ($) : Life Insurance ($) : Description : Other Assets ($) : Total Liabilities ($) : Description : Total Net Worth ($) : Total Assets ($) :


Real Estate 1
Address : Date Purchased : Original Cost : Present Value : Mortgage Balance :


Real Estate 2
Address : Date Purchased : Original Cost : Present Value : Mortgage Balance :


Real Estate 3
Address : Date Purchased : Original Cost : Present Value : Mortgage Balance :


Annual Sources of Income
Salary ($) : Investment ($) : Real Estate Income ($) : Other ($) : Description : Total ($) : What are your personal monthly living expenses? :


Total Contingent Liabilities
Loan Co-signature : Legal Judgement : Income Taxes : Other Special Debt : Total :


Specific Data
When would you be ready to invest in your franchise if you were approved ? : What skills/experience do you have that will help you be successful in this business ? : Why do you think this franchise will enable you to reach your personal goals? : Who will be responsible for the daily operation of your store? : Amount of cash available for investment? : Have you been approved for financing? : YesNo Amount Approved ($) : Would this business be your sole income source? : YesNo Do you have any contingent liabilities for guarantees, endorsements, leases etc ? : YesNo Are you now, or have you ever been party to any lawsuit - either as defendant or plaintiff ? : YesNo Have you ever been convicted of any offense (including misdemeanors for which you have fined $ 200 or more) ? : YesNo Have you ever been convicted of a felony? : YesNo If so, explain : Have you ever filed for bankruptcy? : YesNo Date Filed : Date Discharged :


Area / Location Preferences
Preference 1 : Preference 2 : Preference 3 :


Please list the three main questions you have about this business opportunity
Question1 : Question2 : Question3 : Captcha ( Enter the text you see in the image below ) Captcha