Confidential Qualification Information
Thank you for your interest in Molly Maid, Inc. In order to help us better understand your background and financial position we need you to complete this brief questionnaire. This information will help our team to determine if this business may be the right fit for you. The submission of this information is required in order to proceed with your research; however it places no continuing obligation on either Molly Maid, Inc. or you, the prospective franchise owner. This information will be held in strict confidence. If you prefer, you may also print this form and fax it to us at (734) 822-6666 or save it and email it to .
Please complete all fields –Thank You.
PERSONAL INFORMATION
First Name
Last Name
Street Address
City
State
Zip
Phone # (s) - - / -- / --
Email Address @.
Please list any potential business partners
Education (Please state your highest grade/level/degree completed)
If applicable, what was your college major?
FAMILY INFORMATION
Marital Status
Spouse’s Name
Does your spouse Work?
Spouse’s Type of Work
Spouse’s Annual Earnings $
Names/Ages of Children
# Dependents (incl. yourself)
OCCUPATIONAL HISTORY
List most recent jobs first
1: Dates Employed
Business Name
Position
Annual Earnings
2: Dates Employed
Business Name
Position
Annual Earnings
3: Dates Employed
Business Name
Position
Annual Earnings
FINANCIAL INFORMATION(Include joint assets if shared by you and spouse)
APPLICANT ASSETS / APPLICANT LIABILITIESSavings & Checking / Notes Due Others
Investments / Credit Card Debt
Real Estate - Home / Mortgage Balance
Other Real Estate / Home Equity Loan/ 2nd Mortgage
Retirement Accounts / Unpaid Taxes
Business Net Worth / Total Liabilities
*Other Assets / Other
Net Worth
*(Please describe any other assets here. Please excludevehicles andpersonal property, such as furniture, jewelry, etc.)
Has any business in which you were an officer, director, or shareholder ever failed, filed bankruptcy or become insolvent or compromised debts?
If yes, give details:
Are any lawsuits or legal actions pending against you or any business interests you might have?
If yes, give details:
Does Molly Maid have permission to run your credit report and background check? (Yes or No)
1. Do you certify that the information you have provided on this form is complete and correct?
(Yes or No)
2. Do you authorizeMolly Maid or its authorized agents to obtain verification of any of the above information, and further authorize the release of such information to Molly Maid? (Yes or No)
Again, please SAVE this document and either fax it back to (734) 822-6666 or email it to .
Molly Maid, Inc.
3948 Ranchero Drive | Ann Arbor, Michigan48108
Phone: 800-886-6559