Personal Information :
Title
Mr.
Mrs. Ms. Miss
First Name*
Last Name*
Email Address*
Company
Position
Home Address
City*
State/Province*
Select
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, D.C.
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Nfld. & Lab.
Nova Scotia
Prince Edward Is.
Ontario
Quebec
Saskatchewan
ZIP/Postal Code
How did you hear about Premier Wheel Workz?
Select
RTO Online Website
RTO Magazine
A Friend
Internet Search Engine
In the Industry
Investment Magazine
Saw Store Location
APRO Magazine
APRO Website
Other
Contact Numbers:
Number Is it all right to leave a message at this number?
Home Phone*
Yes
No
Work Phone
Yes
No
Mobile Phone
Yes
No
Other
Yes
No
Fax
Contacting You:
What is the best way to contact you?
Select
Email
Phone Call
US Mail
What phone number is the best way to contact you?
Select
Home Number
Work Number
Mobile Phone
Fax
What is the best time to call?*
Select
Most Anytime
Morning / 9am - 12pm
Afternoon / 12pm - 5pm
Evening / 6pm - 9pm
Weekend only
To contact you at home during the week, do you have a regular day off?
None
Monday
Tuesday
Wednesday
Thursday
Friday
Your Work Experience:
Are you currently in the
Auto Sales / Auto Rental / Rental-Purchase industries?*
Select
Yes Previously - Not Now No - Never
If so,
with what company are you working now?
Please Explain (Include names of companies, periods of employment, and job
descriptions).
Have you owned a business?
Select
Yes - Now Yes - Previously No - Never
Was it a franchised/licensed business?
Select
Yes No
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? *
Select
Yes
No
If YES, please explain.
Financial
Are you interested in
obtaining Premier Wheel Workz's help with SBA financing?
Select
Yes No Possibly
(Details )
I
have a net worth of
No Response
$10,000+ $15,000+ $25,000+ $50,000+ $100,000+ $200,000+
Amount I plan to personally invest in my Premier Wheel Workz dealership*
No Response
$10,000+ $15,000+ $25,000+ $50,000+ $75,000+ $100,000+
Store Location(s)
& Business Information:
In what city and state are you interested in opening your business?*
In what state do you plan to incorporate your business?
Select
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, D.C.
West Virginia
Wisconsin
Wyoming
Do you plan to have any partners in the business with you?
Select
Yes No
If
Yes, Premier is required to
also provide them
disclosure information about the Premier Wheel Workz system. Please list their
name(s) and home mailing address(es).
Are you prepared to open within 90-120 days?
Select
Yes
No
General
Information:
Would you like to receive periodic email updates
on the Premier Companies?
Select
Yes No
To what email address do you want it mailed?
Additional Comments :
