Lead Qualification Details
Lead Qualification Details
Fields marked with
*
are mandatory.
Personal Information
*
First Name :
*
Last Name :
*
Email :
*
Date :
*
Present Address :
*
City :
*
State / Province :
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip / Postal Code :
*
Country :
Select Country
Cyprus
USA
.
*
Primary Phone :
Education Completed :
High School
College
Graduate Degree
*
US Citizen :
Yes
No
BIrth date :
Spouse Name :
Spouse US Citizen :
Yes
No
Spouse Birth Date :
.
Employment
*
Present Employer :
*
Title :
*
Address :
*
City :
*
Zip/Postal Code :
*
Start Date :
*
Salary Per Year :
Hours Per Week :
Select
0-20
21-30
31-40
41-50
51-60
Above 60
*
Brief description of current position :
*
Have you previously been self-employed? :
Yes
No
*
Have you ever owned operated or worked with any firm that provides products or services similar to ours? :
Yes
No
*
Have you ever signed a contract or non-competitor agreement that might limit or disqualify you from owning/operating a franchise? :
Yes
No
Assets and Liabilities
If you would prefer to submit an updated Personal Financial Statement rather than complete this section, please email to banderson@pizzaranch.com.
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 ($) :
Other Liabilities ($) :
Whole Life / Cash Value ($) :
Description :
Other Assets ($) :
Total Liabilities ($) :
Description :
Total Assets ($) :
Total Net Worth ($) :
Real Estate 1
Real Estate Address 1 :
Real Estate Date Purchased 1 :
Real Estate Original Cost 1 :
Real Estate Present Value 1 :
Real Estate Mortgage Balance 1 :
Real Estate 2
Real Estate Address 2 :
Real Estate Date Purchased 2 :
Real Estate Original Cost 2 :
Real Estate Present Value 2 :
Real Estate Mortgage Balance 2 :
Real Estate 3
Real Estate Address 3 :
Real Estate Date Purchased 3 :
Real Estate Original Cost 3 :
Real Estate Present Value 3 :
Real Estate Mortgage Balance 3 :
Equity Partner #1
Name 1 :
Ownership 1 :
Investment 1 :
Equity Partner #2
Name 2 :
Ownership 2 :
Investment 2 :
Equity Partner #3
Name 3 :
Ownership 3 :
Investment 3 :
Franchisee Referral
Were you referred by a Pizza Ranch Franchisee? If so please share their contact information so we can acknowledge him/her. :
Annual Sources of Income
Salary ($) :
Investments ($) :
Real Estate Income ($) :
Other ($) :
Description :
Total ($) :
Total Contingent Liabilities
Loan Co-signature :
Legal Judgement :
Income Taxes :
Other Special Debt :
Total :
Specific Data
*
When will you be ready to invest in your franchise if you are 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 restaurant? :
*
Are you now, or have you ever been party to any lawsuit - either as defendant or plaintiff ? :
Yes
No
Have you been pre-approved for financing? :
Yes
No
*
Have you ever been convicted of a felony? :
Yes
No
Amount Pre-Approved ($) :
*
Have you ever filed for bankruptcy? :
Yes
No
*
Will this business be your sole income source? :
Yes
No
Date Discharged :
Have you ever been convicted of any offense (including misdemeanors for which you have been fined $ 200 or more) ? :
Yes
No
Date :
If so, explain :
Area / Market Preferences
*
Preference 1 :
Preference 2 :
Preference 3 :
Please list the three main questions you have about this business opportunity
Question1 :
Question2 :
Question3 :