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What is your first name?

What is your last name?

What is your e-mail address?

What's the best phone number to be contacted on?

Which country are you looking to open a franchise?

Which country are you from?

Which city are you from?

Portfolio or LinkdeIn URL

Where did you hear about VRXtra?

What is your ideal timeline for investing?

Right Now (1 – 2 Months) In less than a year (2 – 12 Months) More than a year from now. (12 Months+)

What is your estimated net worth?

Less than £500,000 Between £500,000 and £2,000,000 More than £2,000,000

What value of liquid assets do you hold available?

Less than £200,000 Between £200,000 and £1,000,000 More than £1,000,000

Do you have any other means of securing the required minimum financial amount

Yes No

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