PFQ Form - Sparkle Wash Franchise

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Social Security Number

Driver's License Number

Phone Number

Date of Birth

Month

Day

Year

Employer’s Name and Address Length of Employment

If under one year list previous employer and years employed

What territory(ies) are you interested in opening a Sparkle Wash franchise in?

Preferred Method of Contact:*

Phone
Email

Will your purchase of a Sparkle Wash Franchise be a joint venture?

Yes
No

If Phone is preferred, what is the best time to call?*

: HH

MM

If buying a Sparkle Wash franchise is a joint venture please fill in this area:

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number

Driver's License Number

Date of Birth

Month

Day

Year

Social Security Number

Relationship to Applicant

Statement of financial condition as of

EDUCATION

(Select the highest grade completed)

Do you have a High School Diploma?

Yes
No

Did you attend any college?

Yes
No

College:

What was your college major?

Have you served in the Military?

Yes
No

Rank (if applicable)

FAMILY

Marital Status:

Married
Single

Spouse’s Name (if applicable)

Will your spouse be assisting you with your business decision?

Yes
No

PROFESSIONAL

Are you currently employed?

Yes
No

If yes, please briefly describe your job title and responsibilities.

Have you ever been self-employed?

Yes
No

If yes, briefly describe your self employment experience.

On a scale of 1 – 5 please rate your level of experience in each of these areas:

(1 being no experience and 5 being 3+ years of experience)

Outside Sales

Inside Sales

Managing Employees

Basic Accounting Skills

Marketing

Problem Solving Skills

Computer Skills

I like to work with my hands?

Yes
No

I like to work outdoors?

Yes
No

ASSETS & LIABILITIES

Cash on hand: savings account

Notes payable (banks, finance companies)

Cash on hand: checking account

Credit card balances

Home at market value

Home mortgage

Other real estate

Other mortgages or loans

Loans receivable from others

Loans payable to individuals

Securities: marketable stocks & bonds

Debt against securities

IRAs, 401k, other Retirement Plans

Unpaid taxes or other obligations

Own business at market value

Auto, boat, RV loan balances

Autos, boats, RVs, other vehicles

Business liabilities

Other assets (describe)

Other liabilities (describe)

TOTAL ASSETS

TOTAL LIABILITIES

NET WORTH (total assets minus total liabilities)

Sources of income for year ended

INCOME & EXPENDITURES

Gross salary or wages

Mortgage/rental payments

Bonuses & commissions

Utility payments

Dividends and interest

Real estate taxes/assessments

Net real estate income

Taxes—federal, state & local

Other income (specify) Alimony, child support or separate

Insurance payments

maintenance income need not be revealed.

Car payments, credit cards, etc… Other expenses (describe)

TOTAL INCOME

TOTAL EXPENDITURES

Each undersigned warrants that the information provided is true and complete. I/we further certify that we have reached the age of majority. I/we authorize Sparkle International, Inc. to make all inquiries the company deems necessary to verify the accuracy of statements made herein, and to determine my/our credit worthiness. Sparkle International, Inc. is authorized to provide and/or obtain information about credit experience with me/us.

Applicant signature

Date

Joint applicant signature, if joint application