Dollar Store Initial Qualification Form

Simply fill out the information below and click the Set Up button.
Required entries are shown in green.

E-mail address


Full name
e.g., John H. Doe)

First M. Last









Zip Code




Primary phone #


Evening phone #


Fax #


Time to Call:

Optional Info


How did you first hear about DollarStore, Inc.?

I am most interested in:

Highest level of education:

Annual household income:

How soon would you like to open your own business?

Less than 90 days
3 to 6 months
6 to 12 months
More than 1 year
Amount of liquid capital available? $25,001 - $50,000
$50,001 - $100,000
$100,001 and up
Approximate net worth? $50,001 - $99,999
$100,000 - $199,999
$200,000 and up

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