Confidential Questionnaire

"*" indicates required fields

1Overview

2Franchise Plans

3Employment

4Legal

5Financials

Business Experience and Employment Information
Please provide a comprehensive record of your professional experience, starting from your current or most recent position. This should also include any military service you have had.

What is your highest level of education?*

Have you been in business for yourself?*

Employment

Status of Employment*

Name of Employer*

Title & Duties*

From*

To*

Salary*

Reason for Separation*

Add Another Employer

Status of Employment

Name of Employer

Title & Duties

From

Salary

Reason for Separation

Add Another Employer 2

Add Another Employer

Status of Employment

Name of Employer

Title & Duties

From

Salary

Reason for Separation

Spouse Background

What is your highest level of education?*

Status of Employment*

Name of Employer*

Title & Duties*

From*

To*

Salary*

Reason for Separation*

Military

Have you ever or do you currently serve in The Armed Services ?*

Yes

Service Branch*

Current or Highest Rank*

Have you heard about our Veteran Discount Program?*

Yes

Confidential Financial Statement and Franchise Investment Funding

Cash in Checking & Savings

Notes Payable

Describe Any Notes Payable

Stocks/Bonds/Securities

Personal Residence Mortgage

Retirement Plan/IRA/401(k)

Other Real Estate Mortgage(s)

Personal Residence (market value)

Auto Loan(s)

Other Real Estate (market value)

Credit Card Balances

Auto(s) (market value)

Taxes Payable

Describe Any Taxes Payable

Value of Your Own Business

Other Liabilities

Describe Other Liabilities

Other Assets

Describe Other Assets

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TOTAL ASSETS

TOTAL LIABILITIES

NET WORTH

Monthly Income

Salary (Monthly)

Bonuses or Commission (Monthly)

Dividends and Interest (Monthly)

Real Estate Income (Monthly)

Other Income (Monthly)

Total Monthly Income

Monthly Expenses

Rent or Mortgage (Monthly)

Utilities (Monthly)

Incidentals (Monthly)

Auto Loans (Monthly)

Credit Card (Monthly)

Medical (Monthly)

Taxes Payable (Monthly)

Other Loans or Notes (Monthly)

Total Monthly Expenses

Please explain Other Income

Difference Between Income & Expenses

Franchise Investment Funding
Corporate Cleaning Group's Estimated Initial Investment Range is $94,740 to $140,700.
Please share your sources of funds for the initial investment:

Source of Funding*
Savings | Checking Amount
Bank Loan
SBA Loan
ROBS Funding
Other Funding

Savings | Checking Amount*

Bank Loan Amount*

SBA Loan Amount*

ROBS Funding Amount*

Other Funding Amount*

Other Funding Explanation*

Total Investment

I / We do hereby represent that all of the above answers are true and complete to the best of my/our knowledge and belief. I / We recognize that this is not in any way an obligation to offer a franchise to me/us because of my/our execution of this document. I / We acknowledge that any false statement on this application shall be considered sufficient cause to deny further consideration. I / We understand that an inquiry regarding my/our character, general reputation, personal characteristics, mode of living and financial background may be made as a result of this application and hereby authorize the release of this information. A photographic copy of this authorization shall be as valid as the original.

Please Sign Full Name*

Signing Date*
MM slash DD slash YYYY