Sample Page 2017-12-01T21:01:02+00:00


Contact Name


Spouse/Partner Name


Address


City


Postal / Zip Code



Country


How long have you lived at this address?


Phone Number


Email


Spouse/Partner Email

Citizenship Status


Dependents

List all dependents as represented on your tax filings



Age

List all dependents as represented on your tax filings





Upload Resume/CV (Optional)


Upload Photo (Optional)


Business Background

Tell us a little about your business experience


Present Employer


Title


Responsibilities


Length of Employment


Annual Salary


Will you be leaving this employment to open your business?


Any other source of income?


Total Combined Income


Have you ever owned your own business?


What type of business?


How long operated


How did you become interested in this business? *


Have you ever managed employees?


If so, at what capacity?


When would you like open?


Whats your primary reason(s) for going into your own business?


What would you consider your strengths in owning your own business?


What would you consider your primary concerns in owning your own business?


In which geographical area would you like to open your business?


Will you be opening this business with a partner?


If so, will this partner be active?


What languages do you speak?

Financial Information


Assets:

Basic financial asset information


Cash on Hand & In Banks


Stocks, Bonds & Securities


Retirement Funds


Loans owed to you (Due w/in 1 yr)


Do You Own or Rent Your Home?


Real Estate: (present value)


Businesses Owned


Any other assets


Liabilities:

Basic liability infomation


Notes payable to Bank


Notes payable2 to individuals


Total credit card debt


Vehicle Loans


Home Mortgage


Other Mortgages


Student Loans


Any other debts


Net Worth:

Assets minus Liabilities


Total Assets


Total Liabilities


Assets - Liabilities = Net Worth


Amount of Capital to Invest


Source of Capital


Closing



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