Application Form - Handyman Franchise Canada

First Name : *

Last Name : *

Date :

Social Security # : *

Birth-Date : *

US Citizen :

Yes No

Email : *

Main Phone : *

Home Phone :

Mobile Phone :

Work Phone :

Present Address :

City : *

State / Province : *

Zip / Postal Code : *

Country : *

How long at this address? (Yrs) :

Home Ownership :

Own Renting

Marital Status :

Single Married

Spouse Name :

Spouse Social Security # :

Spouse Email Address :

Spouse US Citizen :

Yes No

Spouse Birth Date :

Assets and Liabilities

ASSETS

LIABILITIES

Cash on Hand & in Banks ($) :

Marketable Securities ($) :

Accounts / Notes Receivable ($) :

Retirement Plans ($) :

Real Estate ($) :

Personal Property ($) :

Business Holdings ($) :

Life Insurance ($) :

Other Assets ($) :

Description :

Total Assets ($) :

Mortgages ($) :

Accounts Payable ($) :

Notes Payable ($) :

Loans On Life Insurance ($) :

Credit Cards (total balance) ($) :

Unpaid Taxes ($) :

Other Liabilities ($) :

Description :

Total Liabilities ($) :

Total Net Worth ($) :

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 ? :

Why do you think this franchise will enable you to reach your personal goals? :

Are you now, or have you ever been party to any lawsuit - either as defendant or plaintiff ? :

Yes No

Would this business be your sole income source? :

Yes No

Do you have any contingent liabilities for guarantees, endorsements, leases etc ? :

Yes No

Handyman Connection pledges to keep strictly confidential all the information conveyed in this qualification report. We must also insist that you keep absolutely confidential all of the information that we submit to you and your associates. By signing this document I authorize Handyman Connection to obtain information regarding my creditworthiness, standing or capacity, character, general reputation, personal characteristics, or mode of living from any outside source that regularly provides such information. I understand that information from any such report may be used by Handyman Connection in making a decision regarding whether to enter into a business transaction with me. I hereby certify that the information submitted is current, accurate, and complete to the best of my knowledge and belief.

The Lifestyle You Want.