Contact Address (must be home address):


City:


State:


Zip Code:


E-Mail Address:


Home Phone Number:

Work Phone Number:

Cell Phone Number:


Social Security Number (will be filed): not necessary at this time.

What is the best time to contact you?

May we contact you at work?
Select One Yes No

Describe your business background/experience:

*The required initial investment is approximately $5,995.00 to $12,900.00. 
Are you prepared to make an investment in this range?
Select One Yes No

Do you have sufficient income reserves to meet your current living expenses for 12 to 24 months?
Select One Yes No

If No, do you have access to it?
Select One Yes No

On a scale of 1 to 5, please rate your follow up skills (with 5 being the highest): Select One 1 2 3 4 5

Will a partner be involved in this business venture:
Select One Yes No

If selected for a territory, how soon could you start:
Month January February March April May June July August September October November December Year 2004 2005 2006

Do you have any expertise in the advertising/direct mail industry?
Select One Yes No

Are you comfortable working in teams?
Select One Yes No

Would you devote full or part time efforts?
Select One full-time part-time

How many cold calls to merchant's business can you make each day?
Select One One or two Three to five Six to nine Ten to fifteen

How many appointment calls can make per day?
Select One One or two Three to five Six to nine

Have you ever operated your own business?
Select One Yes No

What is your most important career goal?

What would you like to achieve in the next 2-3 years?

What is your action plan to achieve those goals?

In your carreer, which positions have you most enjoyed and why?

What is motivating you to look for new opportunities?

How will you know if you have done a good job?

What is your management style?

What is the biggest professional challenge you have faced?

When considering other individuals in your area, why should we choose you?

What are you looking for in a business?

Give 3 words that describe you?

Additional Questions, Requests or Comments:

How did you hear about Hello New Neighbor!?
Select One Internet Ad Via Email Internal Search Classified Ad Other

I/we certify that the information that I/we have provided on this questionnaire is complete and correct. It is understood and agreed that any material omission or misrepresentation by me/us on this application will be sufficient cause for cancellation of this application and/or other legal remedies on Hello New Neighbor! behalf. I/we hereby authorize Hello New Neighbor! or its authorized agent to obtain any of the above information and I/we authorize the release of such information to Hello New Neighbor! or its authorized agent. I/we hereby release from liability Hello New Neighbor! and its representatives for seeking such information. I/we further authorize release of this information/application to Hello New Neighbor! vendors only after the purchase of an Hello New Neighbor! license. Nothing contained in this Application constitutes an offer to grant a license or the right to use our mark, logo or materials as provided online or in any way or form. Offers may be made by prospectus only. This email and/or the Internet web site do not constitute an offer of a license. Use, completion and submission of information requested hereby signifies and confirms acceptance of the aforementioned conditions and terms as set forth herein. Acceptance in this business program does not constitute a guarantee of success. Individual results will vary from territory to territory and from individual to individual and can not be guaranteed. 

*There may be other methods to ownership, levels of investment and offers to becoming an affiliate or territory owner.