New Investors

 
Investor Qualification Form

Fill out the information below and we will see if you meet the financial requirements to own a coin laundry. All information is kept in the strictest confidence and we will not sell or share this information. Once we evaluate this information, we will contact you with the results of our investigation.

First name *:   Last name *:   Middle initial: Street address *:   Address (cont.) *:   City *:   State/Province *:   Zip/Postal code *:   Country *:   Work Phone *:   Home Phone: FAX: E-mail *:   URL if applicable: What City or area would you like to build your coin laundry? Please provide your Employment Experience in the space below. Please list company name, position held and dates of employment. If you own a business, please provide information in the next box. Have you ever owned a business? If yes, please explain the type of business. Total Assets ($): Total Liabilities ($): Net Worth ($): Cash available ($) to invest: Have you ever filed Bankruptcy? Yes     No Please provide any addition information you would like to share.

Fields with an asterisk * are required.