Justix

Personal Data:
First Name		Last Name
Address 1		Address 2
City		Email address
State Zip code		Phone number

Business/Work History
Previous Employer		Self Employed? Yes No

Business Management Goals:
Do you have access to the funds needed to invest in this franchiseYes No		Describe why you feel the Justix franchise is right for you:
Do you plan to operate the business yourself?Yes No
Comments?		How did you find out about this opportunity?
		Planned date to open?