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Free Franchise Information Package
Because of the large volume of inquiries we receive, only those individuals who complete this Confidential Franchise Application Form will be sent our comprehensive franchise package.

The information you provide will be held in the strictest confidence and completion of this form in no way constitutes a commitment to Premier Homecare Services or that a franchise will be automatically awarded. We encourage you to share any relevant information and include anything that you find will make your candidacy stand out as a potential franchisee. If you are planning to have a business partner or investor, he/she should complete a separate application form. Thank you again for your interest in Premier Homecare Services.
Confidential Franchise Application Form


Contact Information: * Information required to process form.
Applicant:
Spouse:
* First Name: * Last Name:
* Address:
* City:
* Country:
* State/Province:
* Zip/Postal Code:
* Home Phone:
Business Phone:
Cell Phone:
* E-Mail:
Best Time to Call:
Please contact me by:
Home Phone
Business Phone
Cell Phone
E-Mail
How did you hear about us? (Please select from following list)
What is your interest level? Very Interested Somewhat Interested Just Looking
Personal Information:
Your Health:
Please Explain
Social Security Number:
Number of Dependents and Ages:
High School Education Years:
High School Degrees:
College Education:
College Degrees:
Employment/Business History:
Current Employer/Business:
Position:
Address:
City:
State/Province:
Zip/Postal Code:
Business Phone:
Fax:
Can You be Called at This Business Address Location?
Yes No
How Long Have You Been With Your Current/Prior Employer/Business?
Premier Homecare Services Specific Questions:
Have you ever owned your own Business?
Yes No
If Yes, What type/how long?
What Personal or business experiences do you have that would assist you in running your own business?
Why do you feel you would be good at owning and operating a Premier Homecare Services?
Would you be available to operate the business on a full time basis?
Yes No
If Yes, What type/how long?
If Applicable, describe the business and personal background of the alternate manager of the business.
If you operated and managed the business yourself, how many hours per week would you be willing to invest into your own business the first year to insure the business gets the proper start that it needs?
If you did not operate and manage the business, how many hours per week would you make available for assistance, secondary or backup processing and consultation?
In what city or county and state/provice would you like to open and operate your Premier Homecare Services business?
First Choice:
Second Choice:
By what date would you like to begin operating your new business?
Have You Considered Other Types of Franchise?
Yes No
If Yes, What type?
Have you Ever Cared For an Elderly Person?
Yes No
If yes, describe the situation
Why did you investigate the elderly market for your own business?
Financial Information
Assets
Liquid Capital/Savings $
property $
Investments $
Other Assets $
Total Assets $
Liabilities
Bank Loan $
Mortgages $
CreditCards $
Other $
Total Liabilities $
Total Net Worth$
Additional Personal/Business History:
Have you Declared Bankruptcy in the last 15 years?
Yes No
If yes, describe the situation
Have You Ever Been Convicted of a Crime?
Yes No
If yes, describe the situation
Do You Have any pending litigations against you?
Yes No
If yes, describe the situation
Any Litigations Pending Against Others?
Yes No
If yes, describe the situation
Personal References, excluding family or subordinates:
(References will not be called until after a discussion with you)
First Reference:
Name:
Years known:
Relationship:
Phone Number:
Address:
Second Reference:
Name:
Years known:
Relationship:
Phone Number:
Address:
Third Reference:
Name:
Years known:
Relationship:
Phone Number:
Address:

Acknowledgements:
The submission of this application does not obligate me or Premier Homecare Services in any way or manner. I hereby certify that all information provided in this application is true and correct as of the date submitted. I authorize Premier Homecare Services to conduct any necessary credit checks and hereby waive my right conferred upon me by the stature or otherwise regarding any disclosures obtained by Premier Homecare Services. I understand that any false information or consequential omission contained in this application would be cause for immediate terminations of any subsequent agreement reached between myself and Premier Homecare Services.

Confidentiality and Non-Disclosure Agreement:
Premier Homecare Services agrees to provide franchise applicants with pertinent confidential and proprietary documents and information relating to Premier Homecare Services.

By Submitting this online application, you agree that this and any subsequent information received will be held in the strictest confidence and only used for the sole intention of evaluation a Premier Homecare Services Franchise. You further agree that such information shall only be made available to your financial and legal advisors. Your business partners must also submit a complete franchise application to Premier Homecare Services and agree to these Confidentiality and Non-Disclosure terms.