Request For Consideration Questionnaire Request For Consideration Questionnaire Step 1 of 6 16% Personal InformationFirst Name* Last Name City* State*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code*Residence Telephone Cell Telephone*Fax NumberWhen Is Most Convenient Time To Call Email Address Date Of Birth (Month /day/ Year)* MM slash DD slash YYYY Marital Status*Marital Status*MarriedWidowedSeparatedDivorcedSingleU.s. Citizen Yes No EducationHighest Grade Completed in High School Highest Grade Completed in College List Degree(S) Other Education Completed & Dates Business HistoryPresent 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 & HobbiesInterests & Hobbies* Charities Or Organizations You Belong To* FinancialDo 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 $ GeneralDo 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 Please List In Order The Areas Of PreferenceAddress* 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 & SignIt 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 SignatureBy 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. CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
