Contact - Iris Environmental Franchise

Personal Information
First Name*
Last Name
City*
State*
Zip Code
Residence Telephone
Cell Telephone*
Fax Number
When Is Most Convenient Time To Call
Email Address
Date Of Birth (Month /day/ Year)*
MM slash DD slash YYYY
Marital Status*
U.s. Citizen
- Yes
- No

Education
Highest Grade Completed in High School
Highest Grade Completed in College
List Degree(S)
Other Education Completed & Dates

Business History
Present Employment*
Brief Description of Responsibilities*
Prior Employment
Brief Description of Responsibilities*
Have You Ever Owned Any Other Business Not Listed Above
- Yes
- No
What is Your Strongest Business Aptitude:
- Customer Service
- Marketing
- Accounting
What Did You Like Most About Your Job Or Business*
What Was Least Desireable About Your Job Or Business*
Your Strengths Are*
What Is Your Greatest Achievement*
Your Weaknesses Are*

Interests & Hobbies
Interests & Hobbies*
Charities Or Organizations You Belong To*

Financial
Do You Own Or Rent Your Home
- Own
- Rent
Monthly Mortgage Or Rent $*
Years Lived At Present Address
Years Lived In Present City
How Many Automobiles Do You Own
What Are They
Do You Have A Financing Source?
- Yes
- No
What Is Your Financing Source

Assets*
Liabilities*
US Government Securities $
Unpaid Income Tax $
Listed Securities & Current Market Value
Real Estate Mortgages Payable $
Unlisted Securities $
Mortgages & Other Liens Payable $
Owned Automobiles & Personal Property $
Other Debts Itemized
Cash Value Life Insurance
Notes Payable $
Retirement Plans & IRA’s
Total Credit Card Debt $
Real Estate Owned
Other Liabilities $
Other Assets*
Total Assets $
Total Liabilities $*
Net Worth*

Income – Self
Income – Spouse
Bonus Income $
Bonus Income $
Other Income $
Other Income $
Total Income $
Total Liabilities $

General
Do You Plan To Operate The Business Yourself
- Yes
- No
If Not, Who Will
Do You Intend To Have A Partner
- Yes
- No
If Yes, Who
Do You And/Or Your Partner Have Any Experience In Mold And/Or Asbestos? Please Explain*
Do You Have A Preference As To The Area Or City Where You Would Like To Have Your Business Located, If So
Do You Have A Preference As To The Area Or City Where You Would Like To Have Your Business Located, If So
Please List In Order The Areas Of Preference

Address*
City State County
Address
City State County
Address
City State County
Address
City State County

Why Do You Wish To Purchase A Franchise Rather Than Becoming Someone’s Employee Or Starting Your Own Business?*
If Your Application Is Approved, When Would You Want To Open Your Business
How Did You Hear About Us*
What Professional Goals Have You Set For Your Future*
Applicant: Please Read & Sign
It is understood that the purpose of this questionnaire is for information only and is in no way binding upon IRIS Alliance, LLC or the applicant. It is, however, understood that the applicant supplies this information contained herein to the best of his or her knowledge and ability and that IRIS Alliance, LLC relies on this fact in assessing the desirability and qualifications of the applicant. This application may require IRIS Alliance, LLC to complete credit and other background checks on all applicants.
Signature*
Date
MM slash DD slash YYYY
Signature
By typing my name in this field and sending the email I attest the desire to submit this form and release my information.
Print Your Name
I agree*
- Participant will not at any time or in any manner, either directly or indirectly, use for personal benefit, divulge, disclose or communicate in any manner any information that is proprietary to IAL. The Participant will protect such information and treat it as strictly confidential. The obligation of the Participant not to disclose confidential information shall continue for a period of three years. All information disclosed in any conversation, documentation or other presentation is considered confidential.Participant will not at any time or in any manner, either directly or indirectly, use for personal benefit, divulge, disclose or communicate in any manner any information that is proprietary to IAL. The Participant will protect such information and treat it as strictly confidential. The obligation of the Participant not to disclose confidential information shall continue for a period of three years. All information disclosed in any conversation, documentation or other presentation is considered confidential.

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