This form is intended to collect information that will give us an overview of your potential to become one of our franchisees. Please note that all information you provide will be treated confidentially.

* Mandatory fields


How were you informed of the availability of Qualiclean franchises?


What type of franchise are you interested in? *

For what territory or region? *

Canadian citizen (or permanent resident)

Language of communication

What is your full name? *

Would you be the sole shareholder in your company?

If not, what is the name of your partner?

Do you own or rent your home? *


Present home address

(Street, apartment #, city, province, postal code)

Are you presently the owner of your company?

If yes, its company name

How much money would you believe to have to invest in installing and starting your franchise?


Email *

Phone number *

(Indicate the phone number where you want to be called)

What is the best moment to contact you? *

Comments and/or questions