Thank you for your continued interest in the LearningRx Franchise Opportunity

Please fill out the additional information below to continue the process. We estimate this form will take about 3o minutes to complete. Please fill it out with as much detail as possible to expedite the process, and click “Submit” when you are finished.

It is important that you use the same email you submitted with the first form, so we can appropriately link your record with the previous information.

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Qualification From

Qualifications Form

  • Contact Information

  • IMPORTANT: Please use the same email address you used for the initial submission, so we are able to link your record appropriately.

  • Additional Info

  • List Additional Business Partners:

  • Rank yourself in the following areas (1=poor 5=strong)

  • Confidential Financial Information

  • Assets(Summary per line - Do NOT itemize)

  • Liabilities(Summary per line - Do NOT itemize)

  • Current Income Status

  • SOURCES OF ANNUAL INCOME(Estimated totals - do NOT Itemize)

  • Business Information

  • Rank yourself in the following areas :

    Please answer the following statements :
    Strongly Disagree, Disagree, Neutral, Agree, Strongly Agree

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