Fields marked with * are mandatory.

Personal Information

*First Name: *Last Name: Date:
*Email: Gender: US Citizen:
Male Female Yes No
Present Address: Social Security #: Home Phone:
Home Phone Extension: Work Phone: Work Phone Extension:
*City: *Country: *State / Province:
*Zip / Postal Code: How long at this address? (Yrs): Previous Address:
City: Country: State / Province:
Zip / Postal Code: Birth Date: Best Time To Call:
Home Ownership: Marital Status: Spouse Name:
Own Renting Single Married
Spouse Social Security #: Spouse US Citizen: Spouse Birth Date:
Yes No

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 ($):    
Life Insurance (CSV) ($):    
Other Assets ($): Other Liabilities ($):
Description: Description:

Total Assets:

Total Liabilities:

Total Net Worth:


Real Estate Owned

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 ($):

Total Contingent Liabilities

Loan Co-signature: Legal Judgment: 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?:
Yes No
Amount Approved ($): Would this business be your sole income source?: Do you have any contingent liabilities for guarantees, endorsements, leases etc ?:
Yes No Yes No
Are you now, or have you ever been party to any lawsuit - either as defendant or plaintiff ?: Have you ever been convicted of any offense (including misdemeanors for which you have fined $ 200 or more) ?:
Yes No Yes No
Have you ever been convicted of a felony?: If so, explain:
Yes No
Have you ever filed for bankruptcy?: Date Filed: Date Discharged:
Yes No

Area / Location Preferences

Preference 1: Preference 2: Preference 3:

Please list the three main questions you have about this business opportunity

Question 1: Question 2: Question 3:
I attest that the information provided herein is true and correct to the best of my knowledge. I understand that Lawn Doctor, Inc. may utilize the services of a consumer reporting agency to verify the information I have provided in this application to evaluate my qualifications as a Lawn Doctor franchisee and/or share the information with lending institutions of my choice to assess my ability to obtain financing. I understand the investigation may include obtaining information regarding my creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living and will be obtained for the purpose of evaluating my qualifications and verifying the information contained in this questionnaire. I hereby authorize Lawn Doctor, Inc. to obtain a consumer report or make other inquiries about the information described herein and I hereby release Lawn Doctor, Inc., its employees, representatives and agents from any liability as a result of the reporting of such information.
*I Accept:  *Signature: