Franchise Tax Prep Class

1 BUSINESS INFORMATION

2 PERSONAL INFORMATION

3 EDUCATION

4 PERSONAL EXPERIENCE (Begin with most recent)

5 GEOGRAPHIC INFORMATION

6 PACKAGE INFORMATION

7 APPLICANT SIGNATURE

8 DEBIT AUTHORIZATION

Employer# 1
Employer
Phone Number
Position Hold
From
To
Address
Street Address Address Line 2 City State ZIP Code
Brief Description of responsibilities
Employer# 2
Employer
Phone Number
Position Hold
From
To
Address
Street Address Address Line 2 City State ZIP Code
Brief Description of responsibilities
Have you ever or do you currently own your own business or franchise? If yes, what type and describe responsibilities/experience?
What are your financial goals in owning a 101TaxSolution Center
What other reasons do you want to own a 101TaxSolution Center
Will any family members be involved in the decision of purchasing a franchise, or in the management of 101TaxSoft office? If so, who?

Assets
Liabilities
Checking Account Balance ($)
Home Mortgage Balance ($)
Savings Account Balance ($)
Credit Cards ($)
Stocks & Bonds ($)
Autos ($)
Real Estate Owned ($)
Real Estate Loans ($)
Home Equity ($)
Other ($)
Money Market Accounts ($)
Other ($)
Total Assets ($)
Total Liabilities ($)
Net Worth (Assets less Liabilities) ($)
Gross Annual Income ($)
Have you ever filed for bankruptcy?
- Yes
- No
How would you finance your franchise?
APPLICANT SIGNATURE
Neither the submission of this application nor anything contained in this application shall be deemed to obligate 101TSC to offer or sell a franchise to you or to otherwise commit or bind PRO-TAX to enter into any contractual or other relationship with you. The granting of franchise rights is at the sole discretion of 101TSC, and will be accomplished, if at all, only by execution of a Franchise Agreement by 101TSC and you.

By signing below, you warrant that all of the information submitted in connection with this application, including any financial statements attached to this Application, is true and accurate as of the date below; and, you agree to notify 101TSC of any material change in your personal, business or financial status while this application is pending.
Signature
Date (MM/DD/YYYY)
Date Format: MM slash DD slash YYYY
Credit Card Number
Expiration Date (MM/YYYY)
CCV
Address
Street Address City State ZIP Code

Debit Authorization
Name of Financial Institution
Address of Financial Institution
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Holder Signature
Date
Date Format: MM slash DD slash YYYY
Account Holder Name
Account Holder Address
Street Address City State ZIP Code
- Recurring Payment
- One Time Payment
Routing Number
Checking/Saving Number
*
By entering the phone number, you agree to Self-serve's TOS. Message and data rates may apply.*
CAPTCHA

Debit Authorization