Franchise Application

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PERSONAL INFORMATION
Today's Date:
First Name: MI: Last Name:
Address:
City: State: SELECT ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DIST OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING ZIP:
Rent/Own? How Long (In Years)?
Home Telephone: Cell Phone:
Email:
Your Birthday: Your Age:
APPLICANT’S FRANCHISE PLANS
Will the franchise be owned and operated by yourself, family members or a group?
How soon do you want to start business? Please explain fully.
Amount of capital available for this business. Describe fully.
Territory for which application made:
Would you consider any other area? Yes No	What Area(s)?
EDUCATION
Please list educational background starting with the highest degree received:
Degree Institution 1: Address: Years Completed: Degree Institution 2: Address: Years Completed: Degree Institution 3: Address: Years Completed:
BUSINESS AND EXPERIENCE RECORD
Have you been in business for yourself? Describe fully.
Name and address of current employer:
Position, title and duties:
Dates of Employment: From: To:
CONFIDENTIAL FINANCIAL STATEMENT
Please enter whole numbers only without decimals, commas or any other characters and 0 where applicable
Assets
Cash (On hand, and unrestricted in banks.)
U.S. Government Securities
Accounts and Loans Receivable
Life Insurance, Cash Surrender Value (Do not deduct loans)
Other Stocks and Bonds
Real Estate
Automobiles
OTHER ASSETS
Total ASSETS
Liabilities and Net Worth
Notes Payable to Banks (Unsecured Direct Borrowings only.)
Notes Payable to Banks (Secured Direct Borrowings only.)
Notes Receivable, Discounted with Banks, Finance Companies, etc.
Notes Payable to Other, Unsecured
Loans Against Life Insurance
Accounts Payable
Interest Payable
Taxes and Assessments Payable
Mortgages Payable on Real Estate
Other Liabilities (Itemize)
TOTAL LIABILITIES
NET WORTH

 

This is not an offering. A prospectus, filed first with the Department of Law of the State of New York, can only make an offering. Such filing does not constitute approval by the Department of Law.

**This franchise is not being offered to the residents of the following states: California, Florida, Hawaii, Illinois, Indiana, Kentucky, Maine, Maryland, Michigan, Minnesota, Nebraska, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota, Texas, Utah, Virginia, Washington, Wisconsin.

This offer is not directed to any person in the states listed above by or on behalf of the franchisor or anyone acting with the franchisor's knowledge. No franchises can be sold in the states listed above until offering has been registered and declared effective by the appropriate regulatory authority and the uniform franchise disclosure document has been delivered to the offeree before the sale within the applicable time frame.

This franchise is offered only by delivery of a franchise disclosure document

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