Company Name:

First Name:

Last Name:

Street Address 1:

Street Address 2:

City:

State:

Zip/Postal Code:

Daytime/Work Phone:

Evening/Home Phone:

Cell Phone:

FAX:

E-mail:

Desired Dealer Territory 1:

Desired Dealer Territory 2:

Desired Dealer Territory 3:

Will you have partners besides you?:

If yes, please explain who will be partnering with you?:

How did you hear about Basement Transformation Technologies?:

If Other Please Explain:

Do you have experience in Basement Finishing?:

Do You Currently Offer Basement Finishing Services?:

If Yes Please Explain:

Describe your business and/or professional background::

Have you ever owned a business?:

If Yes Please Explain:

Are you currently employed?:

If Yes Please Explain:

Have you declared bankruptcy in the last 10 years?:

If Yes Please Explain:

Your Assets: Cash $:

Stocks, bonds, mutual funds – non retirement accounts $:

Stock, bonds, mutual funds – retirement accounts $:

Value of all real estate owned $:

Other Assets $:

Total Assets $:

Please explain any assets you listed as Other:

How much of your own money are you looking to invest in this franchise? $:

Your Liabilities Total mortgages on all real estate $:

Other Liabilities $:

Total Liabilities $:

Please explain any liabilities you listed as other:

Net Worth Assets minus liabilities $:

As of today, based on what you know about Basement Transformation Technologies, please rate your overall interest in owning a Basement Technologies Dealership:

You promise that you have supplied all information to the best of your ability and understand that we rely upon this information in assessing your qualifications. You understand that this profile is not a contract and is in no way binding on you or us, and does not mean or imply that a franchise will be offered: