Lead Qualification Details
Lead Qualification Details
Fields marked with
*
are mandatory.
Personal Information
*
First Name :
*
Last Name :
*
Mobile :
*
Email :
*
Country :
Select Country
Algeria
Argentina
Australia
Austria
Belgium
Brazil
Canada
China
Cyprus
France
Germany
India
Italy
New Zealand
Poland
South Africa
South Korea
Thailand
United Kingdom
USA
Zimbabwe
Home Phone :
Present Address :
Spouse Name :
Work Phone :
*
City :
Are you legally able to work in Canada :
Yes
No
BirthYear :
*
Zip / Postal Code :
*
State / Province :
Select State
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Assets and Liabilities
ASSETS
LIABILITIES
Cash on Hand & in Banks ($) :
Mortgages ($) :
Marketable Securities ($) :
Accounts Payable ($) :
Accounts / Notes Receivable ($) :
Notes Payable ($) :
Retirement Plans ($) :
Loans On Life Insurance ($) :
Real Estate ($) :
Credit Cards (total balance) ($) :
Personal Property ($) :
Unpaid Taxes ($) :
Business Holdings ($) :
Other Liabilities ($) :
Life Insurance ($) :
Description :
Other Assets ($) :
Total Liabilities ($) :
Description :
Total Net Worth ($) :
Total Assets ($) :
To receive a proper assessment of your application, please ensure to complete this section as thoroughly as possible.
Real Estate 1
Address :
Date Purchased :
Original Cost :
Present Value :
Mortgage Balance :
Real Estate 2
Address :
Date Purchased :
Original Cost :
Present Value :
Mortgage Balance :
Real Estate 3
Address :
Date Purchased :
Original Cost :
Present Value :
Mortgage Balance :
Annual Sources of Income
Salary ($) :
Investment ($) :
Real Estate Income ($) :
Other ($) :
Description :
Total ($) :
Specific Data
When would you be ready to invest in your franchise if you were approved ? :
What skills/experience do you have that will help you be successful in this business ? :
Who will be responsible for the daily operation of your store? :
Have you ever filed for bankruptcy? :
Yes
No
Amount of cash available for investment? :
Would this business be your sole income source? :
Yes
No
If filed for bankruptcy please explain. :
Have you ever been convicted of any Crime? :
Yes
No
How would you cope with unexpected losses as the business is building and any other set backs? :
Where did you hear about Booster Juice? :
Do you have a net worth of at least 350k and liquid capital of at least 150k :
Yes
No
What else do you think we should know about to understand you better and to better determine what your association with us could mean? :
List three references please include their name phone number and relationship to you :
Area / Location Preferences
Preference 1 :
Preference 2 :
Preference 3 :
Please list the three main questions you have about this business opportunity
Question1 :
Question2 :
Question3 :
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