Personal Data

Franchise brand you are applying for:

Surname:

First Name:

Home Address:

City:

Country

Postal/Zip Code:

Email:

Date of Birth:

Tel. # Home:"

Tel. # Home:

Tel. # Office:

May we contact you at your business phone?

Fax #:

Spouse’s First Name:

Spouse’s First Last Name:

Have you ever been convicted of anything other than minor traffic violations?
 Yes No
Are you involved in pending litigation?
 Yes No
Have you or your spouse ever declared personal bankruptcy?
 Yes No

Education

High School:

University/College:

Degree:

Describe any training in sales, management or retail:

Current Business Experience

Occupation:

Date:

Company Name:

Position:

Describe duties, number of employees supervised and responsibilities:

Previous Business Experience

Occupation:

Company Name:

Position:

Describe duties, number of employees supervised and responsibilities:

Previous Business Experience

Occupation:

Company Name:

Position:

Describe duties, number of employees supervised and responsibilities:

Business Ownership Information

Have you ever you’re your own business or franchise?

Have you ever had a business failure? If so, please explain:

Financial

Assets

Cash Available $
Stocks, Bonds & Securities $
Accts, Notes Receivable $
Real Estate (Market Value) $
Mortgage Receivable $
Business Accounts $
Retirement holdings $
Other Financial Sources $
Other assets $
TOTAL $

Liabilities

Unpaid Taxes $
Loans $
Other bank loans $
Mortgage loans $
Other Liabilities $
Other Fiancial Commitments $
TOTAL $

Describe Real Estate:

Describe Securities:

Mortgage Payment:
Monthly

Financial Loan payments

Name of Bank / Finance Company / Credit Card Holder

Name Address Phone Contact