Franchise Interest Form

This short form allows us to better qualify you as a prospective franchisee with our company. Please complete all the required fields below and a representative will contact you to discuss the program and any additional questions you might have.

This form is not a contract and all information obtained will remain private. Serious inquiries only, U.S. residents only.

Personal information

First Name
Last Name
Spouse First Name
Spouse Last Name

Address 2
Zip Code

Cell Phone
Email Address

Background information

     Yes   No  
If Yes, what type of business?
Total years of education
Your role in previous business
Degrees and/or credentials

Other Businesses you are considering
Why does our franchise appeal to you?
What are your reasons for wanting to be in business for yourself?
Why would you make a great franchise owner?
Preferred Franchise Location
1.  2.  3.

How do you rate your skills with people? (10 being highest)    
How do you rate your leadership skill? (10 being highest)    
Will anyone be running the franchise with you?     Yes   No
When do you intend to purchase a franchise?    

Financial Information (Please enter numbers only)

Capital available (from cash, savings, checking, money markets, etc.) $
Home Equity $
Securities (Stocks, Bonds, Mutual Funds, etc.) $
IRA's/401K's $
Other sources of funding $
Total $

References (Must not be related)


Optional Information

Please share any information with us that you believe is beneficial in evaluating you for franchise ownership

Contact Agreement

By clicking "I Agree" you authorize Assisted Living Locators and/or its affiliates in pursuant to 47 C.F.R. § 64.1200(a)(3)(iii) - Code of Federal Regulations to contact you at the particular telephone number or numbers that you have provided through means that may include automatic telephone dialing systems and/or artificial or prerecorded voice. You are not not required to agree (directly or indirectly), or agree to enter into such an agreement as a condition of purchasing any property, goods, or services. Assisted Living Locators will not review budgets or financial projections prior to execution of the franchise agreement.

This form is not an offer of a franchise opportunity. An offer of a franchise can only be made by a Franchise Disclosure Document which has been registered and declared effective in your state.