All information denoted with an asterisk (
*
) must be completed.
Personal Information
*
First Name
*
E-mail
*
Last Name
Street Address
City
State / Province
Postal / ZIP
Country
*
Best phone number to contact you at:
What is the best time of day to contact you?
Select one...
Morning
Afternoon
Evening
Business Experience, Management & Goals
Current Occupation:
*
Available Investment Capital:
20-44K
45-74K
75-110K
110K plus
What is your net worth?
50-99K
100-199K
200-299K
300-499K plus
500K plus
Please list the top 5 areas you would be interested in opening a U Weight Loss Clinic
*
*
When would you like to start?
As soon as possible
3-6 months
6-12 months
not sure
Have you ever been involved in a franchise?
Yes
No
If Yes, please explain.
Have you ever owned, in whole or in part, a business
Yes
No
If Yes, please explain your involvement.
Are you currently involved/participating in any other business venture?
Yes
No
If Yes, please describe.
Do you plan to devote full time effort to this franchise opportunity?
Yes
No
If No, please explain.
Do you have any family members who would be actively involved in the franchise?
If yes, name and relationship:
Name:
Relationship:
Why do you believe the U Weight Loss program will be of interest in your market(s)?
Please identify any partners/associates/investors who would join you in this venture and their approximate percent of ownership.
Name:
Ownership (%):
Name:
Ownership (%):
How did you learn about us?
Do you have any additional comments or questions?
Thank you for taking the time to enquire about U Weight Loss Clinics. Someone will be in touch with you very shortly to help you proceed with the next step.
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