PERSONAL INFORMATION

Today's Date:
First Name:MI: Last Name:
Address:
City: State: 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? 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