Application Form

Phone: 0800 CHEMDRY (243-6379)

Fax: (06) 879-7828

To enable us to forward you your personal information package, we need you to complete the following questions...

(You can also print and fax to (06) 879-7828)

	Full Name:
	Phone Number:
	Email Address:
	Geographical Area of Interest:
	Address:
	City:
	Please tell us a little about yourself:
	1. Are you a business owner?
	Yes:    No:
	2. Have you ever owned a business?
	Yes:    No:
	3. How did you hear about Chem-Dry?
	Website yahoo.com Franchise Solutions Entrepreneur Magazine Be the Boss Franchise Handbook Bus. Op. Handbook Canadian Franchise Association Newpaper Small Bus. Op. Mag. Carpet Cleaned by Chem-Dry Friend Used Chem-Dry retail products Talk Radio Other
	4. Initially, would you plan to work?
	Full time:   Part time:
	5. Would you have a partner in the business?
	Yes:    No:
	6. How long have you lived in the area you would be operating the business?
	0-1 yr:    2-5 yrs:  5-10 yrs:  10+ yrs:
	7. Would you consider moving if there wasn't a franchise available in your area?
	Yes:    No:
	8. How soon would you like to be in business?
	ASAP:    1-3 mo.:  3-6 mo.:  6-12 mo.:
	9. The initial investment for the Franchise is $18,950, plus a recommended $10,000 working capital. Is the money available to you, if we mutually agree this is the right opportunity?
	Yes:    No:
	10. What is the best time to reach you?
	Daytime:   Evenings:   Weekends: