Franchise Application
Personal Data
* First Name:
* Last Name:
Date of Birth:
Spouse's First Name:
Spouse's Last Name:
Date of Birth:
Email:
Number of Children:
Children's Age:
* Address 1:
Address 2:
* City:
* State:
* Zip/Postal Code:
Daytime Phone:
Evening Phone:
Best Time to Call:
* Geographical Area of Interest:
Activities, Hobbies and Interest:
Highest Education:
What are your major questions and concerns about
Mr. Waterheater?
What are your strengths and weaknesses relating to managing a business?
What attracts you to Mr. Waterheater?
When would you like to have your Mr. Waterheater franchise operating?
Current Employment/ Business Ownership
Current or Last Position:
Duties:
Annual Salary:
Spouses Employment:
Spouse Position:
Spouse Duties:
Spouse Salary:
Business Name:
Business Ownership Experience:
Annual Revenue:
Location:
Number of Employees:
Financials-Assets
Cash on Hand:
Savings:
Stocks, Bonds, Mutual Funds:
Retirement, IRA's, 401K:
Home Value:
Second Home Value or Other Estate:
Autos:
Value of Business:
Other Assets:
Financials-Liabilities
Credit Card Balances:
Outstanding Balances on Mortgage:
Other Real Estate Debt:
Auto Loans:
School Loans:
Other Liabilities:
I AUTHORIZE Mr. Waterheater to obtain an investigative/consumer/credit report on me through the credit or consumer reporting agency of its choice in connection with my franchise application. Mr. Waterheater will evaluate the findings of the report(s) in terms of the business necessities of the franchise. I hereby authorize without reservation, any party or agency contacted by Mr. Waterheater to furnish the above-mentioned information.
Form will be submitted over a secure internet connection (SSL) to Mr. Waterheater via email.