Hi-Tech Industries, Inc.
9418 Irondale Ave.
Chatsworth, Ca. 91311
fax= 702-878-4959
PERSONAL INFO ....
Name:_________________________________________________________________________
Address:_______________________________________________________________________
City:___________________________________Province/State:_____________ Postal/Zip Code:________
Home Tel. #:___________________________________________________________________
Bus Tel. #:_____________________________________________________________________
e-mail address:_________________________________________________________________
How long at present address?:______________________________________________________
Previous Address:______________________________________________________________
How Long:____________________________________________________________________
Age: _______ Marital Status:____________________# of Dependent Children:________
Spouse's Name:_________________________________________________________________________
BUSINESS INFO ...
Occupation:_____________________________________________________________________
Name of Employer:______________________________________________________________________
Business Address:_______________________________________________________________________
City:___________________________________Province/State:_____________ Postal/Zip Code:________
Position and duties:________________________________________________________________________
How long with this firm?:_________________________________________________________________________
(NOTE: YOUR PRESENT EMPLOYER WILL NOT BE CONTACTED WITHOUT YOUR AUTHORIZATION)
(Fill in only If you are Self Employed)
Name of Business:______________________________________________________________________
Address:_______________________________________________________________________
City:___________________________________Province/State:_____________ Postal/Zip Code:________
# of People in Organization ?? Adm. ( ) Sales ( )
Brief description of business:______________________________________________________________________
How Long?: ___________________________________________________________________
GENERAL INFO ...
Have you ever been in business for yourself ? ________________________________________
If "Yes" - what kind of business ?: _________________________________________________
If you went into business for yourself to what degree could you invest ?: $_________________________
Your Own Capital $_____________________________________________________________
Borrowed $____________________________________________________________________
Immediately Available $____________________________________________________________________________
Will you be able to devote the time that is needed to supervise this business ?____________________________________________________________________________
If not, who do you plan to have do it ?____________________________________________________________________________
Do you understand that the success of your business depends upon the efficiency with which you handle your accounts ?_____________________________________________________________________________
If your application is accepted, how soon can you start ?_____________________________________________________________________________
REFERENCES...
Names and Telephone numbers of three character references:
1)-___________________________________________________________________________
2)-___________________________________________________________________________
3)-___________________________________________________________________________
Names and Telephone Numbers of three credit references: (if you are already
in business)
1)-___________________________________________________________________________
2)-___________________________________________________________________________
3)-___________________________________________________________________________
I understand that this is NOT a contract, and this form incurs no
obligation on either party.
I certify that the above information is complete and correct ...
Your Name :_____________________________________________________________________________
Date:__________________________________________________________________________
ADDITIONAL ....
(Please use this space or add extra pages to tell us anything else which you think is relevant, such as family business history, your personal business objectives, tax considerations, outstanding business ventures in which you have participated, etc....)