| First Name | |
| Last Name | |
| Email Address | |
| Country | |
| Address 1 | |
| Address 2 | |
| City | |
| State/Province | |
| Postal Code | |
| Work Phone | |
| Home Phone | |
| Cell Phone | |
| Best Time to Call | |
| Date of Birth | |
How much liquid capital do you have available to invest in NAPA store ownership? |
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| Are you interested in? | Establishing a new store(s) Buying an existing store(s) |
| Please indicate your geographic area of interest | |
| How did you learn about NAPA store ownership |
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| Comments | (400 char max) |
| To the best of my knowledge, everything that I have stated in this preliminary evaluation is true. |
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Completion and submission of this Preliminary Evaluation to NAPA AUTO PARTS constitutes a representation of all the information in the form, by the person identified in the first line above, upon whom NAPA AUTO PARTS may rely. Disclaimer |
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