REQUEST FOR INFORMATION   Please complete and return this information request form to help us learn more about you and be better prepared to assist you. All information will be handled in complete confidence. We will not contact your present employer. THIS IS NOT A CONTRACT AND DOES NOT INCUR OBLIGATION ON EITHER PARTY.   Contact Information   Name Date of Birth (first)                             (M.I.)                              (last) Address City State Zip Own Rent How long?   Telephone Numbers: Day ( ) Evening ( ) Mobile ( ) Private Email:   Please check boxes where confidential messages may be left: Day Phone Evening Phone Mobile Phone   Qualifications   What about your experience, education or background makes you qualified to own and/or operate a business?   General Information   What makes you want to own a business?   What do you think will be the most challenging part of being a business owner?   What do you think is your strongest attribute that will help your business succeed?   In terms of purchasing a business I am Mildly Interested Very Interested Ready To Purchase   Have you ever owned or operated a business? Yes Full-time Part-time No   If yes, explain   How did you first become aware of our company? Friend/Associate Internet Ad Newspaper Ad Web Site Mailer Other   Acquisition Criteria   What type of business would you like to buy? 1 st Choice Why? 2 nd Choice Why?   What price range of a business do you want to buy? to   What annual compensation do you need to generate to meet your financial obligations?   How much do you anticipate investing from personal funding?   What are the sources of initial investment? Savings Home Equity Investments □ IRA   What cash flow (ROI) do you expect to generate from the business on this investment?   When do you plan to buy a business?   In what geographic area would you prefer to buy a business?   Are you willing to relocate for the right opportunity? Yes No   Would you consider buying a new franchise? Yes No   Please use the space below to summarize your personal goals and objectives in establishing your business:   By submitting this form the buyer understands that qualifying information may be disclosed to the sellers of businesses whom the buyer expresses interest in.   “Your Success is Our Priority”   National Headquarters 10500 Barkley, Suite 225 Overland Park , KS 66212 Phone 913-381-5426 * Fax 913-381-5978