Please complete the form below if you would like to receive more information on our Franchise Opportunities.

Personal Information

*First Name:
*Last Name:
*Email Address:
*Home Address:
*City:
*Country:
*State/Province:
*Zip/Postal Code:
*Home Phone:
*Cell Phone:
*Work Phone:
*Best Time to be Reached:
*Current Occupation:

General Information

*How Did you Hear About Us?
*Preferred Locations:

Financial Information

(A copy of your most recent W-2 or 1040 form will be required prior to being granted a franchise)
Cash Available:
Net Worth:
*Do you have a source of financing?
*Will You Have Partners or Other Investors?
Do you currently own, or have you ever owned your own business?
If yes, please describe (500 character limit):
Will you be able to devote the time that is needed for a new business?
If no, please explain how you will handle the daily operations of your business (500 character limit):

This information does not constitute an offer or sale of a 1-800-905-GEEK franchise. Each potential franchisee should independently evaluate the opportunity that a 1-800-905-GEEK business provides with the appropriate advice from your business consultants, attorneys and accountants. This information is not provided as an offering of a franchise but as background information appropriate for you to consider investing and developing a 1-800-905-GEEK business. The offer of a 1-800-905-GEEK franchise is by prospectus only.

Currently, the following states regulate the offer and sale of franchises: California, Hawaii, Illinois, Indiana, Maryland, Michigan, Minnesota, New York, North Dakota, Oregon, Rhode Island, South Dakota, Virginia, Washington, and Wisconsin. If you are a resident of one of these states, we will not offer you a franchise unless and until we have complied with applicable pre-sale registration and disclosure requirements in your jurisdiction.