Franchise Application

Contact Information:



Current Address:  

Own:       Rent:          How Long?  

Phone Numbers:    

Best Time Available:  



Marital Status:  

Spouse's Name:  

Names / Ages of Children:  


Personal References:


Name:           Name:  

Address:          Address:  

Phone:          Phone:  

Relationship:           Relationship:  


Business Experience:


Current Employer:  

Job Title:           How Long?  


Previous Employer:  

Job Title:           How Long?  


Reason For Leaving:  

Describe Additional Employment Background:


Describe Educational Background: 



Your Franchise Plans:


Franchise would be owned and operated by:   

Have you owned a business before?    

What Type?  

Describe your experience:  

Why do you feel you would be successful?  

Preferred Market Areas (City / State):  

How will you obtain funding?  


Credit References:


Account / Type:        Account / Type:  

Name:        Name:  

Address:       Address:  

Phone:         Phone:  

Have you ever filed for bankruptcy:         When:  

Have you ever been convicted of a felony or other offense?    

If yes, Please explain:  


Copyright 2003 Professional House Doctors, Inc. All rights reserved.
Revised: 06/02/07