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Personal Information

  • First name: [[contact.firstname]]
  • Last name: [[contact.lastname]]
  • Email: [[contact.email]]
  • Phone number: [[contact.phone]]
  • Street address: [[contact.address]]
  • City: [[contact.city]]
  • Zip Code: [[contact.zip]]
  • State/Region: [[contact.state]]
  • Have You Owned a Business Before:  [[contact.qs__background___owned_a_business__cloned_]]
  • Have You Been Part of a Franchise System Before:  [[contact.qs__background___part_of_a_franchise_system__cloned_]]

 

Availability

  • Best Time To Call: [[contact.qs__best_time_to_call]]

Annual Sources of Income

  • Annual Salary:
    [[contact.qs__income_sources___annual_salary]]

  • Spouses Annual Salary: [[contact.qs__income_sources___spouses_annual_salary]]

  • Bonuses and Commissions:
    [[contact.qs__income_sources___bonuses_and_commissions]]

  • From Investments:
    [[contact.qs__income_sources___from_investments]]

  • Real Estate Income:
    [[contact.qs__income_sources___real_estate_income]]

  • Other:
    [[contact.qs__income_sources___other]]

  • Other Description:
    [[contact.qs__income_sources___other_description]]

Area Preferences

  • Area Preference - 1 City, state - (EG - Boston, MA):
    [[contact.qs__area_preference___1]]

  • Area Preference - 2:
    [[contact.qs__area_preference___2]]

  • Area Preference - 3:
    [[contact.qs__area_preference___3]]

Main Questions About The Business

  • Main Question 1:
    [[contact.qs__main_question_1]]

  • Main Question 2:
    [[contact.qs__main_question_2]]

  • Main Question 3:
    [[contact.qs__main_question_3]]

Goals Assessment

  • Why are you seeking a business of your own?: [[contact.qs__goal_assessment___why_are_you_seeking_or_expanding_a_business_of_your_own_]]
  • Why are you interested in PIRTEK USA?: [[contact.qs__goal_assessment___why_are_you_interested_in_pirtek_usa_]]
  • Describe your present occupation and your role.: [[contact.qs__goal_assessment___describe_your_present_occupation_and_your_role_]]
  • What contract groups, associations, or franchises are you affiliated with?: [[contact.qs__goal_assessment___what_contract_groups__associations__or_franchises_are_you_affiliated_with_]]
  • What do you think makes the difference between success and failure?: [[contact.qs__goal_assessment___what_do_you_think_makes_the_difference_between_success_and_failure_]]
  • What was your greatest business or personal accomplishment?: [[contact.qs__goal_assessment___what_was_your_greatest_business_or_personal_accomplishment_]]
  • What was your greatest business or personal disappointment?: [[contact.qs__goal_assessment___what_was_your_greatest_business_or_personal_disappointment_]]
  • When making a business decision, who encourages you the most?: [[contact.qs__goal_assessment___when_making_a_business_decision__who_encourages_you_the_most]]
  • When making a business decision, who cautions you the most?: [[contact.qs__goal_assessment___when_making_a_business_decision__who_cautions_you_the_most]]
Most importance to you:
  • #1: [[contact.qs__goal_assessment___aspects_most_importance_to_you__1]]
  • #2: [[contact.qs__goal_assessment___aspects_most_importance_to_you__2]]
  • #3: [[contact.qs__goal_assessment___aspects_most_importance_to_you__3]]
  • #4: [[contact.qs__goal_assessment___aspects_most_importance_to_you__4]]
  • #5: [[contact.qs__goal_assessment___aspects_most_importance_to_you__5]]
  • #6: [[contact.qs__goal_assessment___aspects_most_importance_to_you__6]]

What is your succession plan?:
[[contact.qs__goal_assessment__what_is_your_succession_plan__for_passing_your_business_to_your_heirs__for_sel]]

Comments: [[contact.qs__goal_assessment___comments]]

Background Information

  • Full Legal Name as it appears on identification:  [[contact.qs__background_information___full_legal_name_as_it_appears_on_identification]]
  • Citizenship: [[contact.qs__background_information___citizenship]]
  • Military Veteran: [[contact.qs__background_information___military_veteran]]
  • Have you ever been convicted or charged of a misdemeanor (other than a traffic violation)?: [[contact.qs__criminal_history___have_you_ever_been_convicted_or_charged_of_a_misdemeanor_other_than_a]]
  • Please Explain: [[contact.qs__criminal_history___please_explain_misdemeanor]]
  • Have you ever been convicted or charged of a felony?: [[contact.qs__criminal_history___have_you_ever_been_convicted_or_charged_of_a_felony___cloned_]]
  • Please Explain: [[contact.qs__criminal_history___please_explain_felony]]
  • Have you ever been convicted or charged of DUI or DWI?: [[contact.qs__criminal_history___have_you_ever_been_convicted_or_charged_of_dui_or_dwi___cloned_]]
  • Please Explain: [[contact.qs__criminal_history___please_explain_dui_dwi]]

Civil History

  • Do you have any existing or pending tax liens?: [[contact.qs__civil_history___do_you_have_any_existing_or_pending_tax_liens___cloned_]]
  • Please explain: [[contact.qs__civil_history___please_explain_tax_liens_]]
  • Have you ever filed or have any pending or discharged bankruptcy?: [[contact.qs__civil_history___have_you_ever_filed_or_have_any_pending_or_discharged_bankruptcy___cloned___clo]]
  • Please explain: [[contact.qs__civil_history___please_explain_bankruptcy_]]
  • Do you have any pending, or filed civil litigation against you? (Personal or Business): [[contact.qs__civil_history___pending__or_filed_civil_litigation_against_you___cloned_]]
  • Please explain: [[contact.qs__civil_history___please_explain_civil_litigation_]]
 

Financial Information (Assets)

  • Cash on Hand in Bank: [[contact.qs__financial___cash_on_hand_in_bank]]
  • Value of Primary Residence: [[contact.qs__financial___value_of_primary_residence]]
  • Value of 401(K): [[contact.qs__financial___value_of_401_k_]]
  • Value of IRA: [[contact.qs__financial___value_of_ira]]
  • Value of Retirement Fund: [[contact.qs__financial___value_of_retirement_fund]]
  • Value of Commercial Real Estate: [[contact.qs__financial___value_of_commercial_real_estate]]
  • Value of Other Real Estate: [[contact.qs__financial___value_of_other_real_estate]]
  • Value of Automobiles: [[contact.qs__financial___value_of_automobiles]]
  • Value of Businesses: [[contact.qs__financial___value_of_businesses]]
  • Value of Profit Sharing: [[contact.qs__financial___value_of_profit_sharing]]
  • Value of Marketable Securities: [[contact.qs__financial___value_of_marketable_securities]]

Financial Information (Liabilities)

  • Primary Mortgage:
    [[contact.qs__financial_liabilities___primary_mortage]]

  • 2nd Mortgage:
    [[contact.qs__financial_liabilities___2nd_mortage]]

  • Vehicle Loans:
    [[contact.qs__financial_liabilities___vehicle_loans]]

  • Credit Cards:
    [[contact.qs__financial_liabilities___credit_cards]]

  • Lines of Credit:
    [[contact.qs__financial_liabilities___lines_of_credit]]

  • School Loans:
    [[contact.qs__financial_liabilities___school_loans]]

  • Business Loans:
    [[contact.qs__financial_liabilities___business_loans]]