MrWindow_Pre-Qualification_Form

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					Franchise Pre-Qualification

Please enter data in the gray areas, save the file and email it to:
garry.jalowka@mrwindow.com

Candidate

Full Name
Address                                                      State
City                                                         Zip Code
Home Telephone                                               Country
Work Telephone                                               Email
Mobile Telephone                                             Best time to contact
How long at this residence?                                  DOB

Candidate's Spouse

Full Name
Address                                                      State
City                                                         Zip Code
Home Telephone                                               Country
Work Telephone                                               Email
Mobile Telephone                                             Best time to contact

Candidate's Business Partner

Full Name
Address                                                      State
City                                                         Zip Code
Home Telephone                                               Country
Work Telephone                                               Email
Mobile Telephone                                             Best time to contact

Employment History                  (Most Recent Position First)

Employer                                        Start Date                          End Date
Salary                                          Position

Employer                                        Start Date                          End Date
Salary                                          Position

Employer                                        Start Date                          End Date
Salary                                          Position

Education

High School
College                                                      Degree
College                                                      Degree
Other Institution                                            Certification
Other Institution                                            Certification

Financial Information

Assets                                                       Liabilities
Savings/Checking                                          Mortgage Balance
Stocks/Bonds                                              Auto Loans
Notes Receivable                                          Credit Card Debt
Retirement Funds                                          Personal Loans
Real Estate                                               Notes Payable
Business Value                                            Business Loans
Other Assets                                              Other Liabilities

What source or sources of funds do you plan to use for this franchise?        (please indicate your options below)

SBA Loan                                                  Bank
SBA Micro Loan                                            Credit Union
Mr Window Finance                                         Home Equity Loan
Personal Credit Line                                      401K Plan
Other

What is the total amount of your financing sources available to you?          $

What is the amount of liquid capital you have to start a business?            $



References

Name                                                      Relationship
Contact Telephone                                         Number of Years Known

Name                                                      Relationship
Contact Telephone                                         Number of Years Known

Name                                                      Relationship
Contact Telephone                                         Number of Years Known



Qualification Questions

Have you been convicted of a felony in the past 7 years?
Have you declared bankruptcy in the past 7 years?
Have you ever been convicted of any crime besides for traffic?
If you answered "Yes" to either of the above questions, please explain:




Are you a partner or officer in any other venture?
If you answered "Yes" to the above question, please explain:




Why are you interested in owning a franchise?




Will this franchise be owned and operated by yourself or a group?
Will this business be your sole source of income?

Are you (or any other member of your family) in the cleaning or service industry?
If you answered "Yes" to either of the above questions, please explain:




Are you currently under any form of non-compete agreement that limits your right
to operate a Mr Window Franchise?

Are you currently investigating any other franchises or business opportunities?
If "Yes" please explain which other opportunities you are looking in to:




Which two people would be attending our 2 week training program?
Name:                                           Phone:
Name:                                           Phone:

Territory for which you are applying for?   (list by city and zip code)




Would you consider any other areas?
If "Yes" please explain which other areas you would like:




Please include any other information that you believe would help you qualify:




By submitting this form I authorize Mr Window Franchise Corporation to make inquiries as necessary to verify the accuracy
of the statements made and to determine my credit worthiness. I certify the above and the statements contained in the
attachments are true and accurate as of the stated date(s). I understand that any FALSE statement may result in denial of a
Mr Window Franchise being awarded to me or termination of my Mr Window Franchise Agreement and may eliminate any
chances of obtaining a Mr Window Franchise in the future.

Sign, date and print your name below. You can also fax or mail this form.
Fax To: (951) 471-2190 or Mail To: Mr Window Franchise Corporation, 15155 Chaumont St, Lake Elsinore, CA 92530

Signature:______________________________            Print:____________________________________         Date:________________

				
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