It is understood that the purpose of this questionnaire is informational only, and is in no way binding upon
either DayriZe/ReOrganiZe Now or the applicant. It is however understood that the applicant has supplied the
information herein to the best of his/her knowledge and ability and that DayriZe/ReOrganiZe Now relies on that
fact in assessing the qualifications and desirability of the applicant. Applicant understands that further
information may be needed to approve the applicant for the purchase of the franchise.
Completing and submitting this questionnaire is only a starting point in our mutual analysis as to
whether we should enter into a franchise relationship. Consequently, your submission of this Questionnaire
is for information purposes only. This questionnaire is not an offer to sell or a solicitation of an offer
to buy a franchise. No sale will occur prior to the execution of a development agreement or franchise
agreement and the payment of all required fees by you. Neither our acceptance of this questionnaire nor any
discussions resulting therefrom constitute any commitment on our part to enter into any agreement to sell
a territory or a franchise.
Please fill out the qualifying information below and someone at DayriZe will contact you to deliver more
detailed Franchise information. The number of Franchise territories are limited, so don’t delay in sending
in your request.
Name:
Spouse Name:
Email Address:
Day Phone:
Evening (home) Phone:
Street Address:
City:
State, Zip:
Which DayriZe Representative referred you to this site?
Are you willing to follow our established franchise development procedures?
Yes
No
PERSONAL:
(answers to questions in this area are OPTIONAL)
Single
Married
Separated
Divorced
Number of minor children:
Ages of children:
Your date of birth (mm/dd/yyyy):
Spouse's date of birth:
Have you ever owned your own business/franchise?
Yes
No
If Yes, give details:
FINANCIAL INFORMATION:
Do you have the necessary capital?
Yes
No
Will you need financing for this franchise?
Yes
No
Do you plan on having a partner?
Yes
No
If so, will the partner be active?
Yes
No
Do you plan on having investors?
Yes
No
If so, to what extent?
(Note that all partners and/or investors will be required to submit a completed copy of this form).
Geographical area of preference?
1.
2.
3.
Are you willing to relocate?
Yes
No
When would you like to start your new business?
How did you become interested in DayriZe.com/ReOrganize Now.com?
As you consider your experiences and abilities, why do you feel you can operate a successful business of this type?
