PERSONAL INFORMATION

CRIMINAL BACKGROUND
HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES NO
CONTINGENCIES & BANKRUPTCIES
DO YOU HAVE ANY CONTINGENT LIABILITIES? YES NO
ARE ANY OF YOUR ASSETS PLEDGED? YES NO
ARE YOU A DEFENDANT IN ANY SUITS OR LEGAL ACTIONS? YES NO
HAVE YOU EVER FILED FOR BANKRUPTCY? YES NO
BACKGROUND
DO YOU HAVE SALES, MARKETING OR REAL ESTATE IN YOUR BACKGROUND? YES NO
HAVE YOU OWNED A BUSINESS IN THE PAST? YES NO
HOW LONG HAVE YOU LIVED IN YOUR CURRENT COMMUNITY?
WHAT SKILL OR PERSONALITY TRAIT DO YOU BELIEVE WOULD BEST HELP YOU IN BUSINESS OWNERSHIP?
I submit the foregoing information as my complete and true personal and financial condition as of the date shown below. I acknowledge I have provided truthful and accurate information
TERRITORY IDENTIFICATION REQUEST
1. Please begin by identifying the primary territory you are interested in. Please pick 2 directions – i.e. North and East
2. Please identify townships, neighborhoods, zip codes or areas that you would like to see in your primary territory.
3. Please select a secondary territory. Please pick 2 directions – i.e. North and East and any townships, neighborhoods, or areas that you are interested in for your secondary territory.