Franchise Opportunities Title

We plan to seek franchisees soon in the following markets in New York:

  • Cortland/Ithaca
  • Utica/Rome
  • Syracuse
  • Rochester
  • Auburn/Finger Lakes

Want to learn more about a Cleanstart Franchise?

Complete the form below to prequalify and speed up access to information:

Part I.General Information

Date (required)


Name (required)



Address (required)

Street Address


State / Province / Region

Zip / Postal Code


Home Phone:

Business Phone:

Cell Phone:

Email Address:

Preferred means of contact (cell phone, business phone, home):

Best Time to Call:



Desired area for franchise:


Second choice of location:


Part II. Education

Please list high school, college, graduate school, other education:

Years completed / degree(s) or certification(s) earned / school(s) attended

Part III. Employment History

Please list employment history within the past five years, or three positions held, starting with most current position:

Dates (from/to) / Company / Address / Position

Part IV. Financial Information

Income from present position:

Additional sources of income (please explain):

Additional sources of income (please explain):

When would you consider investment in this franchise:

Date / Year

Part V. References

Personal/ business







Part VI. Other

Have you ever owned or do you presently own a business? If so, please give details:

Have you ever made application for a bond which was refused?

Have you ever filed for bankruptcy, had a real estate loan foreclosed, or had any liens against you? (If yes, please explain):

Have you ever been or are you now a party to any lawsuits? If so, please explain:

Have you ever been convicted of any offense? Include traffic violations for which you were fined $50 or more. If so, explain in full, including date, charge, place, under what name and action taken:

I understand that the information provided is confidential and affirm that it is true to the best of my knowledge. I understand that providing this information does not obligate me to purchase a franchise, nor does it obligate the franchiser to offer a franchise to me.



Currently, (1) This franchise is not being offered to residents of the states listed below; (2) This franchise offer is not directed to any person in the states listed below by or on behalf of the franchisor or anyone acting with the franchisor’s knowledge, and (3) No franchise will be sold in the states listed below by or on behalf of the franchisor until the offering has been registered and declared effective and a Franchise Disclosure Document delivered to the prospective purchaser in compliance with each state’s franchise law.

  • California
  • Connecticut
  • Florida
  • Hawaii
  • Illinois
  • Indiana
  • Kentucky
  • Maryland
  • Michigan
  • Minnesota
  • Nebraska
  • North Dakota
  • Rhode Island
  • South Dakota
  • Texas
  • Utah
  • Virginia
  • Washington
  • Wisconsin

Filling out and submitting this questionnaire is only a starting point in our respective analysis as to whether we should enter into a franchise relationship. Consequently, your submission of this questionnaire is for information purposes only. This questionnaire is not an offer to sell or a solicitation of an offer to buy a franchise. No sale will occur prior to the execution of a Franchise Agreement and the payment of all required fees by you. Neither our acceptance of this questionnaire nor any discussions resulting therefrom constitute any commitment on our part to enter into any agreement to sell a franchise.