United States Locations:

International Locations:

*Title:

*First:

MI:

*Last:

Suffix:

Select NONE II III IV V VI VII JR SR ESQ

Title:

First:

MI:

Last:

Suffix:

Select NONE II III IV V VI VII JR SR ESQ

* Address Line 1:

(Example: 1245 West Avenue)

* Address LIne 2:

* City:

* State:

Please Select State... Other Connecticut New York Rhode Island Massachusetts Vermont New Hampshire Maine New Jersey ---------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ------------- Puerto Rico U.S. Virgin Islands American Samoa District of Columbia Guam

Other:

* Zip/Postal Code:

Country:

Business Phone:

Extension:

(Please Use The Format 860-874-8444)

Mobile Phone:

Extension:

(Please Use The Format 860-874-8444)

* Home Phone:

Extension:

* Email Address:

(Example: info@sealandcoat.com)

Email Address 2:

(Example: info@sealandcoat.com)

Best Contact Method(s):

How much capital do you have available to invest?

Select... None $10,000 - $15,000 $15,000 - $20,000 $20,000 - $25,000 $25,000 - $30,000 $30,000 - $35,000 $35,000 - $40,000 $40,000 - $50,000 $50,000 - $60,000 $60,000 - $70,000 $70,000 - $80,000 $80,000 - $90,000 $90,000 - $100,000 $100,000 - $120,000 $120,000 - $150,000 $150,000 - $200,000 $200,000 - $250,000 $250,000 - $350,000 $350,000 - $500,000 $500,000 - $750,000 $750,000 - $1,000,000 Over $1,000,000 Other

Do you require financing?

Select... Yes No Other

Do you have financing in place?

Select... Yes No Other

What is your net worth?

Select... None $10,000 - $15,000 $15,000 - $20,000 $20,000 - $25,000 $25,000 - $30,000 $30,000 - $35,000 $35,000 - $40,000 $40,000 - $50,000 $50,000 - $60,000 $60,000 - $70,000 $70,000 - $80,000 $80,000 - $90,000 $90,000 - $100,000 $100,000 - $120,000 $120,000 - $150,000 $150,000 - $200,000 $200,000 - $250,000 $250,000 - $350,000 $350,000 - $500,000 $500,000 - $750,000 $750,000 - $1,000,000 Over $1,000,000 Other

How much time do you plan on devoting to your Seal And Coat Franchise?

Select... Part Time Full Time Other

Do you have sales management experience?

Select... Yes No

If yes, select annual revenue:

Select... None $10,000 - $15,000 $15,000 - $20,000 $20,000 - $25,000 $25,000 - $30,000 $30,000 - $35,000 $35,000 - $40,000 $40,000 - $50,000 $50,000 - $60,000 $60,000 - $70,000 $70,000 - $80,000 $80,000 - $90,000 $90,000 - $100,000 $100,000 - $120,000 $120,000 - $150,000 $150,000 - $200,000 $200,000 - $250,000 $250,000 - $350,000 $350,000 - $500,000 $500,000 - $750,000 $750,000 - $1,000,000 Over $1,000,000 Other

If approved, when can you begin training?

Select... Immediately 1 Week 2 Weeks 3 Weeks 4 Weeks 4 to 6 Weeks 6 to 8 Weeks 8 to 10 Weeks 10 to 12 Weeks Over 12 Weeks

How many franchise locations do you foresee opening?

Select... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Over 21 Other

Are you interested in maintaining franchise rights for your entire state?

Select... Yes No

What is your timeline for purchasing a franchise?

Select... Immediately 1-2 Months 2-4 Months 4-6 Months 6-12 Months 12-18 Months 18-24 Months Over 24 Months Just Looking Other

Highest Level Of Education Completed:

Select... High School / GED Some College College Degree High Level Degree

Have you ever owned or operated this type of business before?

Select... Yes No

Company Name:

Website URL:

Year Founded:

Number of Employees:

Select... 1 2 3 4 5 6 7 8 9 10 11-15 15-20 20-30 30-40 40-50 50-60 60-70 70-80 80-100 100-120 120-150 150-170 170-200 Over 200

Gross Annual Sales:

Select... None $10,000 - $15,000 $15,000 - $20,000 $20,000 - $25,000 $25,000 - $30,000 $30,000 - $35,000 $35,000 - $40,000 $40,000 - $50,000 $50,000 - $60,000 $60,000 - $70,000 $70,000 - $80,000 $80,000 - $90,000 $90,000 - $100,000 $100,000 - $120,000 $120,000 - $150,000 $150,000 - $200,000 $200,000 - $250,000 $250,000 - $350,000 $350,000 - $500,000 $500,000 - $750,000 $750,000 - $1,000,000 Over $1,000,000 Other