CONFIDENTIAL QUESTIONNAIRE     Last Name:     First Name:     Regional Development Director:         CONTACT INFORMATION   Evening Telephone: Mobile: Day Telephone: Email: Fax: Address: City: State/Province: Zip/Postal Code: Country:     The Following information is required in evaluating your qualifications to be awarded a WSI franchise. Should you qualify and a mutual interest developss, additional information may be required. This form must be completed before continuing with the WSI franchise selection process. The information you provide will be treated in the fullest confidence and privacy. Completing this questionnarie does NOT obligate you or WSI in any way. If more than one person (or couple) will be involved, please attach a seperate completed form.         GENERAL INFORMATION Have you had prior interest in operating your own business/franchise? Yes No How long have you been looking to start a new business? Have you ever owned or operated your own business? Yes No If yes, what type? In terms of purchasing a business/franchisee I am... Mildly Interested Very Interested Ready to Purchase Do you have experience in... Marketing Management Consulting/Sales Project Management Finance IT Other Will you devote full-time to your business/franchise? Yes No If yes, please submit a completed questionnaire for each person participating in the business. What level of income do you expect/require to draw from the business per year? In which geographical area are you interested in establishing a business? If awarded a WSI franchise, hoe soon are you able to begin your training?             MEMBERSHIPS AND/OR COMMUNITY GROUPS Which social, civic, fraternal, professional or other organization do you belong to, if any?             EDUCATION Do not complete this section if you are providing a Resume or C.V.   Name of School Location of School Year Graduated Certificate or Degree earned High School College Other(include graduate school) Other education or training Computer skills training             EMPLOYMENT Do not complete this section if you are providing a Resume or C.V. Current Employment Type of Business Title/Position Start Date Finish Date Previous Employment Type of Business Title/Position Start Date Finish Date Salary       PRELIMINARY FINANCIAL INFORMATION   What is your total NetWorth?               Signature:       I certify that the information provided on this questionnaire is complete and accurate. It is understood that this is a preliminary application and does not bind any party to any obligation. We thank you for your interest in the WSI franchise opportunity.         Signature: Date:         If you are submitting this form via email, please type your full name above.