Qualification Survey

Name:

Address:

City/State:

Zip:

Phone:

Email:

Cash on hand and in banks

Savings Accounts

Mortgages or Notes Due to Me (investment property income)

Life Insurance – Cash Surrender Value Only

Other Notes(loans)/Accounts Due to Me

Stocks, Bonds, and retirement funds

Automobiles/Boats

Real Estate Owned

Other Assets or Business Ventures not described

Total Assets (total above numbers):

Loan(s) Payable to Bank(s)

Loan(s) Payable to Others

Other Accounts Payable (Credit Cards, lines of credit, etc.)

Other Liabilities (child support, student/medical debt, etc.)

Total Liabilities (add all of the above):

Net Worth (Assets total minus Liabilities total):

Shack (Mobile Kiosk) - Aprox. invest. level ~$80k-99k

Food Truck - Aprox. invest. level ~$90k-115k

Brick & Mortar Store - Aprox. invest. level ~$220k-450k (variance by location/situation)

Drive-thru (starting at $250k)

Other (please specify)