Expression of Interest
Your Details:
Title:
select
Mr
Mrs
Ms
Dr
First Name:
Last Name:
Date of Birth:
1
2
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/
Jan
Feb
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/
Street Address:
Suburb:
Region:
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
NZ
Postcode:
Phone (work):
Phone (home):
Mobile:
Email Address:
Preferred method of contact:
Phone (W)
Phone (H)
Mobile
Email
What prompted you to visit our site?
select
Newspaper Advert.
Referred by Franchisee/Distributor
Have a display box at work
Existing book club member
Saw the van
Are you interested in joining Lifetime as a
Franchisee
Sub-Contractor
Do you have access to a van or commercial motor vehicle?
Yes
No
What are your earnings expectations?:
per week
Are you reasonably fit?
Yes
No
Do you have access to, or are you able to rent, suitable storage facilities:
Yes
No
Your Previous Experience:
What do you currently do for a living?
Have you had previous experience of running your own business?
Yes
No
If answered Yes, please provide brief details
Your Financial Position:
Do you own your own home?
Yes
No
Are you able to invest $10,000 or more?
Yes
No
Do you require finance?
Yes
No
If so how much?
What is your current net worth, including cash in bank?
Please enter any other information you'd like us to know: