Application Form

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: 02 9680 4171)

	Full Name:
	Phone Number:
	Email Address:
	Geographical Area of Interest:
	Address:
	City:
	State:
	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 Bus. Op. Handbook Franchise Handbook 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. What is the best time to reach you?
	Daytime:   Evenings:   Weekends: