Kwik Industries, Inc. | General Interest Profile Form

General Interest Profile Form

Personal Information
Name:
Address:
City:
State:
Zip Code:
Email:
Phone:
Alternate Phone:
Have you ever been involved in a bankruptcy?
Yes		No
Are you involved in any pending lawsuits?
Yes		No

Check the Kwik Brand of interest to you (limit 2):
		Lube & Tune Oil & Lube Brake & Alignment Self Service Car Wash Full Service Car Wash Wash It Kwik Dry Clean Super Center
Check the type of participation of interest to you:
		Owner/Operator Licensee
What type of Kwik brand location are you seeking?
		New Existing
If an "Existing" brand location becomes available within a reasonable distance from one of your Location choices, would you be interested?
Yes		No
First Location Choice
City & State:
Cross Streets/Intersection:
Why does this location interest you?
Second Location Choice
City & State:
Cross Streets/Intersection:
Why does this location interest you?
Third Location Choice
City & State:
Cross Streets/Intersection:
Why does this location interest you?
When would like to be operating your own Kwik brand location? (Select one)
		1-6 Months 7-12 Months 12-24 Months 25+ Months
Additional Information
Work Experience (Emphasize your Management Skills):

Are you a full time owner and/or participant in any other business?
Yes		No
Will a Kwik Center consume your entire business day and work week?
Yes		No
Who will manage the business?
Who will assist with the business?
	Comments:

Thank You!