2000 North 7th Street
Phoenix, AZ
85006
800-443-1253
First Name
Last Name
Address
City
State
Zip Code
Telephone
Fax
Cell Phone
E-mail
Spouse's Name
Your Occupation
Spouse's
Contact Me By:
Home Phone
Business Phone
Cell Phone
Email
Best Time to Contact Me:
Morning
Afternoon
Evening
Where Did You Hear About Us? If Newspaper, Which One?
Have You Owned a Business?
Yes
No
Type?
When?
How Soon Will You Be Ready to Start Your Business?
How Long Have You Been Looking for a Business?
Will You Have Partners Other than Your Spouse?
Yes
No
If So, How Many?
When Do You Plan to Start?
What Other Businesses Have You Looked At?
Which Ones Are You Still Considering?
When You Find the Perfect Business, How Much Are You Prepared to Invest?
Funds Will Come From:
Savings
Credit Card
Home Equity
401(k)
Stock
A Combination
Other
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