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Apply To Be A Basement Technologies Dealer
We appreciate your interest in Basement Technologies. The more information we receive from you, the better we can answer your questions. Please fill out all fields then submit the confidential Request for Dealership Consideration.
Company Name:
First Name:
  *
Last Name:
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Street Address 1:
  *
Street Address 2:
City:
  *
State:
  *
Zip/Postal Code:
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Daytime/Work Phone:
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Evening/Home Phone:
Cell Phone:
FAX:
E-mail:
  *
Desired Dealer Territory 1:
  *
Desired Dealer Territory 2:
Desired Dealer Territory 3:
Will you have partners besides you?:
Yes
No
  *
If yes, please explain who will be partnering with you?:
How did you hear about Basement Technologies?:
Internet
TV
Radio
Newspaper
Magazine
Other
  *
If Other Please Explain:
Do you have experience in Basement Waterproofing?:
Yes
No
  *
Do You Currently Offer Basement Waterproofing Services?:
Yes
No
  *
If Yes Please Explain:
Describe your business and/or professional background::
  *
Have you ever owned a business?:
Yes
No
  *
If Yes Please Explain:
Have you ever owned a franchise, or been part of a dealer network?:
Yes
No
  *
If Yes Please Explain:
Are you currently employed?:
Yes
No
  *
If Yes Please Explain:
Have you declared bankruptcy in the last 10 years?:
Yes
No
  *
If Yes Please Explain:
Your Assets: Cash $:
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Stocks, bonds, mutual funds – non retirement accounts $:
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Stock, bonds, mutual funds – retirement accounts $:
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Value of all real estate owned $:
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Other Assets $:
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Total Assets $:
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Please explain any assets you listed as Other:
How much of your own money are you looking to invest in this franchise? $:
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Your Liabilities Total mortgages on all real estate $:
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Other Liabilities $:
  *
Total Liabilities $:
  *
Please explain any liabilities you listed as other:
Net Worth Assets minus liabilities $:
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As of today, based on what you know about Basement Technologies, please rate your overall interest in owning a Basment Technologies Dealership:
I know about Basement Technologies, I meet your financial requirements and I want to open ASAP
I see and hear your company name everywhere and I'm interested in owning a Basement Technologies dealership
I am very interested in owning my own business, but have never heard of Basement Technologies
I am currently just looking at several different business opportunities
  *
You promise that you have supplied all information to the best of your ability and understand that we rely upon this information in assessing your qualifications. You understand that this profile is not a contract and is in no way binding on you or us, and does not mean or imply that a franchise will be offered:

Yes
  *
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