Application

REQUEST FOR CONSIDERATION FORM

 

The purpose of this Request for Consideration is for general information in evaluating your qualifications to purchase the Pacific Institute of Reflexology. Should you qualify, and a mutual interest develops, we may request additional information.

(To be completed by each proposed partner of the purchase group)

PERSONAL INFORMATION

First Name: _______________________ Last Name: __________________ Address: ______________________________________________________ City: ________________________ Province:__________

Phone Number: _________________ E-mail Address: _________________

 

BUSINESS EXPERIENCE

Present Employer: ______________________________________________ Title/Position: _________________________________________________

 

FINANCIAL INFORMATION

Annual Income: ________________________________________________ Do you have a source of financing? ___________ Where? ______________ Total Liquid Capital available _____________________________________ Estimated Net Worth ____________________________________________

 

OTHER INFORMATION

Preferred Location: _____________ City: ______________ Prov: _______

How did you find out about us? ____________________________________

How did you become interested? __________________________________

 

WHEN ARE YOU INTERESTED IN STARTING?

1 - 3 months 3 - 6 months 6 - 12 months Upon completion of this initial application you will be contacted by a Pacific Institute Reflexology representative to schedule a meeting.

PLEASE ATTACH YOUR RESUME IF AVAILABLE

 

Signature: __________________________ Date: __________________