Axxiom – Franchise Client Profile

Personal Data

First Name

Last Name

Preferred Email

Address

City

County

State

ZIP Code

Mobile Phone

Work Phone

Home Phone

Preferred Phone

Preferred Method of Contact

Phone

Email

Text

Married?

Yes

No

Spouse's Name

Children?

Yes

No

Ages:

Will Your Spouse be Active in Business?

Yes

No

Will Your Children be Active in Business?

Yes

No

Will you have operations or financial partners?

Yes

No

Currently Employed?

Yes

No

Current Occupation?

Currently own a business?

Yes

No

Current Business Type?

Your Education?

Spouse's Education?

Business Information

Why are you exploring business/franchise ownership? What are your goals?

Do you have any particular kinds of businesses in mind? What do you like about them?

Primary Interest (Check all that apply)

Franchise Model (Check all that apply)

Owner/Operator

Executive Model

Passive Owner

List Other Industries

Customer Type (Check all that apply)

B2B

B2C

Sales Generator

Direct Sales

3rd Parties Referrals/Networking

Location based

Advertising/Website Social Media

(Explain Other Venue)

What is your timeframe for having your business operational? Why this timeframe?

Preferred Hours of Operation (Choose all that apply)

Part-time

Will work weekends and nights

Typical 8:00 - 5:00 (Mon - Fri)

Whatever it takes

Financial Information

What is your budget for total investment?

Available Liquid Capital:

Will you be seeking financing?

Yes

No

Net Worth:

Do you want to be referred to a company that specializes in franchise financing?

Yes

No

Financing Type:

Conventional

Family

SBA

Retirement Funds Rollover Conversion

How much income are you projecting to generate from your business in:

Year 1

Year 2:

Year 3:

Citizen?

Yes

No

Bankruptcies?

Yes

No

Felonies?

Yes

No

Comments regarding Citizenship, Bankruptcies, or Felony Convictions

Are you or your spouse a Veteran?

Yes

No

If so, was there an Honorable Discharge?

Yes

No

Year of Discharge

Rank at Discharge

Branch of Military

Brief overview of Military job or duties

Employment/Business Ownership History

Company Name

Type of Business

Title

Dates

Company Name

Type of Business

Title

Dates

Company Name

Type of Business

Title

Dates

Describe Spouse's Work Experience:

What did you like most about your past jobs or businesses?

What did you like least about your past jobs or businesses?

On the basis of your past experience, your strengths are:

On the basis of your past experience, your weaknesses are:

Rate your Skills & Experience

Other Interests

Hobbies, Sports and Recreational Activities:

What Civic, Social or Fraternal Organizations do you belong?

General

Have You Ever Owned a Business?

Yes

No

If yes, describe?

Location for New Business?

1st Location

2nd Location

How far would you travel to your business?

Other than franchises, what other businesses have you considered?

Do you plan to be actively involved in the new business?

Yes

No

If yes, are you prepared to quit your job, and when?

Name any partners in the business. Will they be financial or operations partners?

Partner Name

Phone

Email

Financial

Yes

No

Operations

Yes

No

Partner Name

Phone

Email

Financial

Yes

No

Operations

Yes

No

Partner Name

Phone

Email

Financial

Yes

No

Operations

Yes

No

Will you have any other partners?

Yes

No

Do you believe you can successfully operate your own business? Explain your reasons.

Have you considered buying an existing business?

Yes

No

Have you considered a start-up business of your own?

Yes

No

In the square below each, rank your interest between 0-5 (0 being no interest and 5 being high interest.)

A startup of your own

An existing business

Franchise

Resale Franchise

Explain your ranking of each selection above.

Sales level that you are comfortable with?

Management of Employees:

No Employees

1-5 Employees

6-10 Employees

11+ Employees

Management Style

Risk vs. Opportunity

Net Worth Calculator

Preliminary Financial Information

Enter whole numbers only, please do not use dollar signs, commas, or periods.

Assets

Cash in Bank

Cash in Savings

Stocks, Bonds, Mutual Funds

IRAs, 401Ks, other Retirement Plans

Cash Value - Whole Life Insurance

Real Estate Value - Home

Real Estate Value - Other

Automobiles

Vehicles - Other

Other Assets

Total Assets

Credit Score

Liabilities

Notes Payable - Bank

Notes Payable - Other

Charge Accounts Credit

Cards Balance

Owing on Life Insurance

Mortgage - Home

Mortgage - Other

Due on Automobiles

Due on Vehicles - Other

Other Liabilities

Total Liabilities

Net Worth

Your Current Annual Income (or most recent annual income)

Spouse's Annual Income (or most recent annual income)

Explain Other Sources of Income with Amounts

Taking living expenses into consideration, how long before you will need to take money from the business?

Personality Characteristics

Rate yourself on a scale of 1 to 5 (5 is the strongest) in the following:

Additional Information

Add any additional information that you feel might be useful for selection of a franchise.

Are you currently, or have you in the past year used a Franchise Broker or a Business Broker?

Franchise Broker

Yes

No

Business Broker

Yes

No

Signatures

Type Your Name

Date

Type Spouse's Name

Date

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