JVP Questionnaire

JOINT VENTURE PARTNERSHIP Application
Name
Date of Birth	Social Security #
Address
City			State Zip Code
Home Phone	Work Phone
Fax Number	Email Address
Marital Status	Name				Is your spouse gainfully employed?
Education
High School	Date Graduated
College	Date Graduated					Degree
Other			Date Graduated Degree
Military Service Branch	Highest Rank				Date and Type of Discharge
Other Special Skills
Employment Information
Present or Most Recent Position				From			To
Company
Address		City State Zip
General Duties
Starting Salary	Ending Salary
Previous Position				From			To
Company
Address		City State Zip
General Duties
Starting Salary	Ending Salary

REFERENCES, BUSINESS

Name		Relationship	Years Known
Address	City	State Phone
Name		Relationship	Years Known
Address	City	State Phone
References, Personal
Name		Relationship	Years Known
Address	City	State Phone
Name		Relationship	Years Known
Address	City	State Phone

Additional Information
Are you a U.S. Citizen?

Do you have any Judgments, Liens or Suits pending? If yes, please describe. _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________
Have you ever been convicted of, or plead guilty or no contest to a felony or misdemeanor other than a minor traffic violation? If yes, please describe. _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________
How long have you been seriously looking for a business?
What other types of businesses/franchises have you looked at?
Have you ever owned your own business?
If yes, please describe business.
Where did you hear about Purchase Partners?
Do you have any exposure to selling to or working with OEMs (Original Equipment Manufacturers)?
What geography would you like to cover if awarded a Joint Venture Partnership? Please be specific to boundaries.
If qualified, when would you be ready to invest in a Joint Venture Partnership? Select the range of investment that you can offer in a JVP: $25,000-$49,000 $50,000-$74,000 $75,000+
Will your spouse or other family members be active in this Joint Venture Partnership?
What are your expectations in a Joint Venture Partnership (Please provide specific answers): _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________
Would you like to recommend any other individuals as Prospective JVP Partners that may be interested in other territories? If yes, please provide names below:
Name	Address	Telephone	Active in JVP or franchise?
Name	Address	Telephone	Active in JVP or franchise?
Name	Address	Telephone	Active in JVP or franchise?
Name	Address	Telephone	Active in JVP or franchise?

Personal Background Information Release Form

I __________________________________ warrant that all of the information submitted in connection with this prospective Joint Venture Partnership questionnaire is true and accurate as of the date below. It is understood that the purpose of this questionnaire is for general information and does not constitute an offer by Grenada Fasteners, Inc., d.b.a. Purchase Partners to enter into a Joint Venture Partnership.

I do hereby authorize a review of full disclosure of all records or any part thereof, concerning myself, by and to any duly authorized agent of Purchase Partners whether said records are of public, private or confidential nature. I consent to your release of any and all public and private information that you may have concerning me, my work records, my background, educational records, my financial status, my criminal history record including all arrest records, and complaints or grievances filed by or against me in determining my suitability for a franchise purchase.

I understand that procuring a financial consumer report may be part of the process of considering my candidacy as a franchise owner. Other consumer reports may also include investigative consumer reports obtained from Corporate Screening Services, Inc., 16530 Commerce Court, Cleveland, Ohio 44130-6305 Phone Number 800-229-8606. These investigative reports may include information concerning your character, general reputation, personal characteristics, and mode of living and may include information obtained through interviews. In the event that information from this report is utilized in whole or in part in making an adverse decision with regard to the award of a franchise, before making the adverse decision, I will be notified in writing and provided a copy of the consumer report and a description in writing of my rights under the federal Fair Credit Reporting Act.

I hereby release you, your organization, and all others from liability or damages that may result from furnishing the information requested, including any liability or damages pursuant to any state or federal laws.

__________________________________ __________________________________

Print Name Date

__________________________________ __________________________________

Signature Social Security Number

Complete and Return Via Mail or Fax to:

Purchase Partners™

Attn: JVP Opportunities

2369 Schuetz Road

St. Louis, MO 63146

(314) 567-7334 FAX

Send mail to sales@purchasepartners.com with questions or comments about this web site.

Purchase Partners® is the registered trademark of McLaughlin Metal Sales Company

DISCLAIMER The materials in this site are provided "As Is" and without warranties of any kind, expressed or implied. LIMITATION OF LIABILITY Under no circumstances, including, but not limited to, negligence, shall Purchase Partners be liable for any damages that result from the use of, or the inability to use, the materials in this site.

ISO 9001: 2000 Registered

Certificate Number 1944