Name:

Address:

City:

State/Province:

Zip/Postal Code:

Home Phone Number (*including country code and area code):

Cell Phone Number (*including country code and area code):

Work Phone Number (*including country code and area code):

Best Time to Call :

Email Address:

Capital To Invest
(please choose one) less than 10K
$10,000 - $14,999
$15,000 - $19,999
$20,000 - $24,999
$25,000 - $29,999
$30,000 - $39,999
$40,000 - $49,999
$50,000 - $59,999
$60,000 - $69,999
$70,000 - $79,999
$80,000 - $89,999
$90,000 - $99,999
$100,000 - $124,999
$125,000 - $149,999
$150,000 - $199,999
$200,000 - $299,999
$300,000 - $399,999
$500,000 - $749,999
$750,000 - $999,999
over $1,000,000

Investment Time Frame
(please choose one) now
3-6 months
6-12 months
1 Year+

How did you hear about us?
(please choose one) Visited a salon
Met a franchise owner
Google
Yahoo
Other Internet Search Engine
Franchising website
Franchise or business broker
Franchise publication
Email or direct mail
TV or radio
Other

What interested you in Sharkey's Cuts for Kids?
(please choose one) Want to be my own boss
Love to work with children
Seeking financial independence
Love the haircare industry
Intrigued by the concept
Other

Have you visited a Sharkey's Cuts for Kids Salon?
(please choose one) Yes
No

Preferred business location(s). Please list city, state or region:

What other franchises and business ideas are you investigating?

Comments or Concerns:

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