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Personal Information : |
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Title |
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First Name* |
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Last Name* |
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Email Address* |
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Company |
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Position |
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Home Address |
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City* |
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State/Province* |
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ZIP/Postal Code |
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How did you hear about Premier Wheel Workz? |
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Contact Numbers: |
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Number |
Is it all right to leave a message at this number? |
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Home Phone* |
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YesNo |
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Work Phone |
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YesNo |
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Mobile Phone |
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YesNo |
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Other |
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YesNo |
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Fax |
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Contacting You: |
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What is the best way to contact you?
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What phone number is the best way to contact you? |
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What is the best time to call?* |
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| To contact you at home during the week, do you have a regular day off?
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Your Work Experience:
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Are you currently in the
Auto Sales / Auto Rental / Rental-Purchase industries?* |
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If so,
with what company are you working now? |
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Please Explain (Include names of companies, periods of employment, and job
descriptions). |
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Have you owned a business? |
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Was it a franchised/licensed business? |
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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?* |
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If YES, please explain. |
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Financial
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Are you interested in
obtaining Premier Wheel Workz's help with SBA financing? |
(Details) |
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I
have a net worth of
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Amount I plan to personally invest in my Premier Wheel Workz dealership*
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Store Location(s)
& Business Information: |
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In what city and state are you interested in opening your business?* |
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In what state do you plan to incorporate your business? |
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Do you plan to have any partners in the business with you? |
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If
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Are you prepared to open within 90-120 days? |
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General
Information: |
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Would you like to receive periodic email updates
on the Premier Companies? |
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To what email address do you want it mailed? |
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Additional Comments :
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Required
Please enter the text in the image below : |
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