To get your free sample and business overview, please take a quick minute to fill out this form.
This information is kept confidential and gives us a brief overview of your business background.
Confidential Distributor Questionnaire
First Name:   
Last Name:   
Email:            
Phone:          
Address:                  
City:             
State:           
Country:       
Zip:               

General Information
If our program meets or exceeds your expectations, would you be willing to expand?

If you found your ideal business, would you be able to start immediately?

Have you had prior interest in operating your own business?

How long have you been looking to start a new business?
Have you ever owned or operated your own business?

     If yes, what type?   
In terms of investing in a business I am...
Do you have any experience in...
Marketing Project Management
Management Finance
Consulting/Sales Other
Do you plan to have any partners?

     If yes, please submit a complete questionnaire for each person participating in the business.

     If yes, who is it?  
What is your highest level of education?
 

Set Your Cash Flow Goals
• First, enter in the number of vending machines you will have working for you (packages start at 25 machines and go up to 300 machines)
• Then enter how many estimated vends per day you think they'll generate in a location.
• Then, enter the average sale price per vend (Revive Energy Mints vend for .50)
• Finally, click on Calculate to see your potential gross revenue!
Enter Total Number
of Revive Machines		 Estimated Vends
Per Day * 		Average Sale Price
Per Vend
  
Daily Sales
Weekly Sales
Monthly Sales
Annual Sales
*Our company does not guarantee actual earnings, estimated vends per day, or
average days to empty. The gross revenue calculations created by using the
calculator are determined by the amounts you enter into the calculator fields.
Such results are not a representation by Revive Franchising of your future
financial performance, or a representation or suggestion by Revive Franchising
of your future sales, income, gross or net profit 
If you are chosen for our program, how much do you have to invest towards your business?
How do you plan to support the initial investment for your business if chosen? Give dollar amounts for each below:

SOURCE

DESCRIPTION

AMOUNT $

CASH ON HAND

HOME EQUITY

RETIREMENT/401K

PARTNER/S, SPECIFY $ SHARE BY EACH

CREDIT CARD

CREDIT CARD

CREDIT CARD

OTHER

TOTAL AMOUNT TO INVEST

  
 

Memberships and/or Community Groups

Which social, civic, fraternal, professional or other organizations do you belong to, if any?

Additional Comments (Please tell us why you would be a great Revive distributor):
Disclosure:
This is not a contract or a binding agreement. This does not obligate you or Revive Franchising, LLC in any way. This does not guarantee your acceptance as a qualified and authorized Revive Energy Mints distributor.  
First Name: Last Name: Initials: Date: