Confidential Questionnaire

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Candidate Information

First Name*

Last Name*

Email Address*

Cell Phone*

Home Phone

Work Phone

Spouse / Significant Other First Name

Spouse / Significant Other Last Name

Your Age

Spouse / Significant Other's Age

Primary Address*

Street Address Address Line 2 (Optional) City State ZIP Code

I acknowledge that the above address is my legal primary address?*

Yes, this is my legal primary address

Spouse / Significant Other Cell Phone

Spouse / Significant Other Email

Marital Status

Number of Dependents

Dependent Ages

List ages separated by commas, if applicable.

Are you a U.S. citizen?*

Yes

Are either you or your spouse / significant other a veteran?*

Yes

Were you or your spouse / significant other honorably discharged from the U.S. military?*

Yes

I have not been discharged.

I prefer not to answer

Employment Information

Your Employment

Employment History

Briefly describe your work history and relevant experience.

Current Business or Employer

Current Position

Annual Salary ($)

Enter $0 if this does not apply.

Spouse / Significant Other Employment

Spouse / Significant Other Employment History

Spouse / Significant Other Current Business or Employer

Spouse / Significant Other Current Position

Spouse / Significant Other Annual Salary ($)

Enter $0 if this does not apply.

Business Involvement and Goals

What role will your spouse / significant other play in this business?

Your Business and Management Goals

Do you plan to devote your full time to this business venture?*

Yes

Will your spouse / significant other be active in the franchise?*

Yes

Will this franchise be your primary source of income?*

Yes

Can your spouse's / significant other's income sustain your family's financial needs?*

Yes

N/A

Have you ever owned a business?*

Yes

Do you plan to have a business partner?*

Yes

Do you plan to have investors?*

Yes

If you plan to have a partner or investor in the business, please explain their role.

Financial Information

Enter $0 if a monetary item does not apply. Enter each asset or debt only once. Totals reflect the amounts entered.

Assets

Cash On Hand ($)*

Enter $0 if this does not apply.

Savings / Certificates ($)*

Enter $0 if this does not apply.

Stocks, Bonds & Securities ($)*

Enter $0 if this does not apply.

Retirement Plan — IRA ($)*

Enter $0 if this does not apply.

Is your IRA a Roth IRA?*

Yes

Retirement Plan — 401(k) ($)*

Enter $0 if this does not apply.

Is your 401(k) with your current employer?*

Yes, all of it

Yes, some of it

Home Value ($)*

Enter $0 if this does not apply.

Other Real Estate Value ($)*

Enter $0 if this does not apply.

Auto Value ($)*

Enter $0 if this does not apply.

Personal Property Value ($)*

Enter $0 if this does not apply.

Other Assets ($)*

Enter $0 if this does not apply.

Description of Other Assets

Total Assets ($)

Calculated automatically from the asset amounts above.

Liabilities

Credit Card Balance ($)*

Enter $0 if this does not apply.

Home Mortgage Balance ($)*

Enter $0 if this does not apply.

Other Real Estate Debt ($)*

Enter $0 if this does not apply.

Installment Notes & Contracts ($)*

Enter $0 if this does not apply. Include auto or other installment loans not listed elsewhere.

Bills Payable ($)*

Enter $0 if this does not apply. Include unpaid bills not already included in another debt category.

Other Debt ($)*

Enter $0 if this does not apply. Include debts not listed above.

Other Debt Description

Total Liabilities ($)

Calculated automatically from the liability amounts above.

Net Worth ($)

Total Assets minus Total Liabilities. A negative amount is possible.

Additional Information

What is your credit score range?*

680 or below

681–750

751–799

800+

I do not know

Prefer not to answer

Have you or your spouse / significant other ever been involved in a personal or business bankruptcy?*

Yes

Have you or your spouse / significant other ever been convicted of a crime?*

Yes

Are you or your spouse / significant other currently involved in any pending civil lawsuits?*

Yes

Are you or your spouse / significant other currently under any type of criminal investigation?*

Yes

Are you or your spouse / significant other subject to any civil judgments?*

Yes

Please explain any Yes answers to the previous five questions.

Acknowledgment of Engagement & Communication Consent*

I acknowledge the engagement described below.

By confirming Acknowledgment of Engagement & Communication Consent, I acknowledge that I am engaging with Top Tier Franchising for complimentary franchise consulting services. I understand that this engagement does not establish a contractual obligation, and either party may discontinue the relationship at any time. I also authorize Top Tier Franchising to contact me at the phone number and email address I have provided via telephone calls, text messages, and email regarding franchise opportunities, consultations, and related services. I understand that I may withdraw my communication consent at any time by notifying Top Tier Franchising or replying STOP to text messages.

Signature (Type Your Full Name)*

Type your full name in place of the PDF signature line.

Date*