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	MaxCARE Professional Cleaning Systems 210 TownPark Drive Kennesaw, GA 30144 ph: 678.355.4005 fax: 678.355.4977		Name: Address: City, State, Zip Code: Home Phone Best time to call: Work Phone: Best time to call: Are you currently employed?: YesNo If yes, what is your current occupation?: Who would primarily run your business?: SelfSpousePartnerAbsentee Do you own your home?: YesNo How much liquid cash do you have available to start a business?: $5,000 to $10,000$10,000 to $15,000$15,000 to $20,000$20,000 to $25,000$25,000 to $30,000$30,000 + Where would you like to open an MaxCARE Franchise?: First Choice: Second Choice: Third Choice: How soon would you be able to open your MaxCARE Franchise?: Now3 months6 months1 year Would you need assistance with financing your MaxCARE Franchise?: YesNo Comments:
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