Franchise_Questionnaire – Prime Senior Placement

Confidential Franchise Questionnaire

Please complete and submit questionnaire.

First Name

Last Name

Telephone Number

How did you learn about Prime Senior Placement?

Provide background information pertaining to your previous business experience and employment:

Why and how long have you been interested in owning a business?

Have you or an immediate family member owned a business? If yes, provide info.

What type of business opportunities have you looked into?

What area would you like for your business to be located?

Will you be able to operate this business on a full-time basis?

List your personal achievements.

List your professional achievements.

Do you have any experience in the senior living industry personally? Please explain.

Are there any members of your family who would be involved in your business? What is their background?

Would you agree to take a personality and skill assessment evaluation?

Yes No

Describe what you feel are your strengths that would benefit you in relation to this type of business.

Why do you feel that Prime Senior Placement would be right for you?

If you were able to purchase and start-up a Prime Senior Placement franchise, what would be your short, mid, and long-term goals?

If adjacent territories are available, would you be interested in purchasing an additional territory in your area to have a broader reach and greater financial opportunity?

Yes No

Do you have any current healthcare industry contacts in the area you want to develop?

What amount are you able to invest in this business?

Can you support yourself financially for one year during the startup period of this business?

Yes No

Have you or an immediate family member ever filed for bankruptcy?

Do you or an immediate family member have any previous or current criminal or cival actions filed against you? If yes, please explain.

Signature

Date

Confidential Franchise Questionnaire

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