| Personal Information : |
| Title |
|
| First Name* |
|
| Last Name* |
|
| Email Address* |
|
| Company |
|
| Position |
|
| Home Address* |
|
| City* |
|
| State/Province* |
|
| ZIP/Postal Code |
|
| How did you hear about Premier Wheel Workz? |
|
| |
|
| Contact Numbers: |
| |
Number |
Is it all right to leave a message at this number? |
| Home Phone* |
|
Yes
No
|
| Work Phone |
|
Yes
No
|
| Mobile Phone |
|
Yes
No
|
| Other |
|
Yes
No
|
| Fax |
|
|
| |
|
| Contacting You: |
| What is the best way to contact you? |
|
| What phone number is the best way to contact you? |
|
| What is the best time to call?* |
|
| To contact you at home during the week, do you have a regular day off? |
|
| |
|
| Your Work Experience: |
| Are you currently in the
Auto Sales / Auto Rental / Rental-Purchase industries?* |
|
| If so,
with what company are you working now? |
|
| Please Explain (Include names of companies, periods of employment, and job
descriptions). |
|
| Have you owned a business? |
|
| Was it a franchised/licensed business? |
|
| Do you currently have any employment or contractual obligations
to a rental-purchase company or auto dealer which might prevent you from talking
to Premier Wheel Workz? If so,
to whom, and to what effect?* |
|
| If YES, please explain. |
|
| |
|
| Financial |
| Are you interested in
obtaining Premier Wheel Workz's help with SBA financing? |
(Details) |
| I
have a net worth of |
|
| Amount I plan to personally invest in my Premier Wheel Workz dealership* |
|
| |
|
| Store Location(s)
& Business Information: |
| In what city and state are you interested in opening your business?* |
|
| In what state do you plan to incorporate your business? |
|
| Do you plan to have any partners in the business with you? |
|
| If
|
|
| Are you prepared to open within 90-120 days? |
|
| |
|
| General
Information: |
| Would you like to receive periodic email updates
on the Premier Companies? |
|
| To what email address do you want it mailed? |
|
| Additional Comments : |
|
