Pillar to Post Questionnaire ConfidentialDate* Personal DataName* Current AddressStreet*City*State / Province / Region*Zip / Postal Code*Residing sinceHouseOwnRentOther If you have been at the above address for less than five years, please list former residence:StreetCityState / Province / RegionZip / Postal CodeYears At AddressPhoneEmail* Date of Birth* Social Security / SIN #Driver's License #Issuing State/ProvinceMarital StatusSingleMarriedDivorced/SeparatedAge(s) of Dependent(s)Name of SpouseOccupation of SpouseAre you a Veteran?YesNo EducationHighest level of education completedHigh SchoolAssociate'sUnder GraduateMastersPHDName of School/College/UniversityDiploma/Degree receivedYear Work HistoryAre you presently employed?*YesNo If yes, list details of present employment. If no, list details of most recent employment. Current Position:Name of companyStreet AddressCityState / Province / RegionZip / Postal CodeType of businessYour title/responsibilitiesLength of service with this companyReason for leaving (if applicable) Previous Position:Name of companyStreet AddressCityState / Province / RegionZip / Postal CodeType of businessYour title/responsibilitiesLength of service with this companyWere you promoted within this companyYesNoReason for leaving (if applicable) Other HistoryHave you ever been convicted of a felony offence?*YesNoHave you ever declared bankruptcy?*YesNoIf you have answered yes to either question, please explain* GOALS AND MOTIVATIONSHow long have you been seeking a business?What interests you about a Pillar To Post franchise?What personality traits or qualities do you possess that you feel would enable you to operate a successful small business?What prior experience might have prepared you to operate a home inspection franchise?Do you plan to work full time at your Pillar To Post business?*YesNoIf no, please explainWill you have a partner, other than your spouse?YesNoIf yes, please explainDo you have any family members who will participate?*YesNoAre you presently associated with or have an interest in any other business?*YesNoIf yes, please explainPreferred Geographic Market Area Your Personal Income Goals1st Year3rd Year5th Year Financial InformationI MAKE THE FOLLOWING STATEMENT OF ALL MY ASSETS AND LIABILITIES AS OF (Enter Today's Date or when you've completed this form)* AssetsCash or Savings On HandNon-Retirement InvestmentsAccounts/Loans Receivable401k, IRA, Roth IRA, RRSPValue of Real Estate OwnedCars, boats, household itemsTotal Assets LiabilitiesTotal Credit Card BalancesCar LoansMortgages Payable on Real EstateOther LiabilitiesTotal LiabilitiesNet Worth (assets less liabilities) Source of Income SelfSalary SelfSalary SpouseReal Estate IncomeOther IncomeTotal Annual IncomeMonthly Living ExpensesWill this business be your only source of income?*YesNoTerms and Conditions I Agree I hereby consent to Pillar To Post obtaining my credit or investigation reports in connection with this questionnaire. I hereby further consent to Pillar To Post taking whatever actions it considers necessary to verify the information set forth above. I understand that Pillar To Post will keep all information concerning this questionnaire confidential, and that this questionnaire is not a binding offer or contract from Pillar To Post to grant me a franchise.