Confidential Questionnaire The following information is necessary in evaluating your qualifications to be awarded a Franchise. Should you qualify and a mutual interest develops, additional information may be requested. The information you provide will be treated in the fullest confidence. Completing this questionnaire does NOT obligate you in any way. If more than one person (or couple) will be involved, please complete a separate form.
Where did you here about Repicci's *	Choose one Had product at event Recommended by someone Internet
Personal Information
First Name *
Last Name *
Street Address *
Address Line 2
City *
State *
Zip Code *
Phone Number *
Alternate Phone
Best time to call?
Email *
Spouses Name
Spouses Occupation
Will your spouse be active in the franchise?	Yes   No
If yes, in what capacity?
Business Information
Please discuss your business experience (most recent first)
What is your timeline for starting a business?
What amount of liquid capital are you able to invest?
Do you plan to finance your franchise purchase and your operating costs with your own capital or will you require financing?
Approximate Net Worth
Credit Score
Additional Information
Do you plan to be actively involved in this Franchise?	Yes   No
What qualities do you feel you possess that would make you successful in operating a Franchise?
How will this opportunity help you reach your business and personal goals?
Additional information or comments you may wish to share with us in evaluating your request for consideration: