First Name: *

Last Name: *

Email: *

Cellphone: *

Address: *

Address1: *

City: *

State: *SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming

Zip: *

How would you like to be contacted? Select Voice call Email Text Email only Text only Voice call only No preference

What time of day is best for us to reach you? Select Morning Afternoon Evening No preference

What is your approximate net worth? Select less than $500,000 $500,000 - $750,000 $750,000 - $1 million $1 million - $1.5 million over $2 million

What statement below best describes you at this point in your business career? Please select one.

 I'm new to running my own business.

 I've had less than 5 years' experience of owning my own business.

 I've had more than 5 years' experience of owning my own business.

 I consider myself a seasoned business owner with more than 10 years’ experience in running my own business.

At what stage are you in the process of buying your own business?

 Just beginning the process 3-6 months away from purchasing

 I've looked at a few businesses and will be ready in 3 months

 I'm ready to purchase if the opportunity is right for me

Please give us an idea of how you will finance your business.

 I will finance my business with money from my retirement savings

 I have cash that I will invest

 I will finance using my home equity

 I will finance using a combination of cash, retirement savings, and home equity

 I have a wealthy relative who will support me

 Other

How did you hear about Light Lounge?

If considering a new business opportunity, how many locations of that business would you like to open? Select Just 1 location 2-4 locations 5+ locations Not sure yet

Have you ever owned or operated a franchised business? Select Yes No

Have you had a bankruptcy in the last 10 years?

 Yes

 No

I believe the approximate range of my credit score is:

 600-650

 650-700

 700-750

 750+

Fields marked with an * are mandatory.