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store development
 

Application
 

Application Form

This is application is being sent encrypted over the internet for the protection of your personal privacy. All data you send via this application is completely confidential and will not be shared with or sold to any third party.

* - required fields  
*

First Name:

  M.I.  
*

Last Name:

*

Home Address:

*

City:

*

State:

 Zip Code:
*

Home Phone:
(include area code)

 

Daytime Phone:
(include area code)

 
Fax:
(include area code)
*

Email Address:

* May we contact you at your home number? Yes No
* When is the best time to contact you? AM PM
 
Current Occupation:

  Have you decided to go into business? Yes No
  Timeframe or established date for opening your Milex TuneUp & Brakes location:
0-6 months
6-12 months
date
  Do you have $50,000.00 available cash or liquid assets and the ability to finance additional $95,000.00?
Yes No
  Have you selected a target market?
If so, in where would you like to own a franchise?
  city, county, state, country
Please send us additional comments or questions here:
Please click on the "send" button to send the contents of this application to Milex. We will contact you as soon as possible. Thank you for your interest!

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