Franchising Request for Consideration

Personal Information

Name(Required)

First Last

Email(Required)

Gender

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How many years at this address?

Previous Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Phone Ext.

Work Phone(Required)

Home Phone

When is most convenient time to call?

U.S. Citizen?(Required)

SSN:

Home Ownership

Marital Status:

Spouse Name

First Last

Spouse Birth Date:

Spouse US Citizen?

Which Country?

Spouse Present Employer

Spouse Occupation/Title

Spouse Cell Phone

Fax Number

How did you hear about Double O's Coffee Franchising?

Current Credit Score

Have you ever filed for bankruptcy?

How long ago did you file?

Explanation

Education

Highest Grade Completed in HIGH SCHOOL?

Highest Grade Completed in COLLEGE?

List name(s) og colleges/universities attended and dates attended:

List degree(s):

Other education completed and dates:

Present Employment

Company:(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Start date of employment:(Required)

Job Title:(Required)

Brief Description of Responsibilities:

Current supervisor:

May we contact?

Prior Employment

Company:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Start Date:

Departure Date:

Reason for Leaving:

Job Title:

Departing Annual Salary:

Other Income (Bonus):

Brief Description of Responsibilities:

Prior Supervisor:

May we contact?

Do you or have you ever owned any other business not listed above? - If so, what?

What is your strongest business aptitude?

What did you like most about your job or business?

What was least desirable about your job or business?

What is your greatest achievement?

Your strengths are:

Your weaknesses are:

Interests & Hobbies

Hobbies/Sports/Recreational Interests:

Charities or Organizations You Belong To:

Financial

Do You Own or Rent your home?

Monthly Mortgage or Rent ($):

Mortgage/Rent Payable to:

Years lived at present address:

Years lived in present city:

How many automobiles do you own?

What are they?

Amount of cash you intend to invest in your business ($):

Method of financing:

Do you have a financing source?

What is your financing source?

Assets & Liabilities

Assets

Cash on Hand & in Banks ($):

U.S. Government Securities ($):

Listed Securities & Current Market Value ($):

Unlisted Securities ($):

Owned Automobiles & Personal Property ($):

Cash Value Life Insurance ($):

Retirement Plans & IRA's ($):

Early Withdrawal Penalty for Retirement Plans ($):

Real Estate Owned ($):

Other Assets ($):

Description of Other Assets:

Total Assets ($):

Liabilities

Notes Payable to Bank ($):

Unpaid Income Tax ($):

Real Estate Mortgages Payable ($):

Mortgages & Other Liens Payable ($):

Other Debts ($):

Notes Payable ($):

Total Liabilities ($):

Total Net Worth ($):

Income - Self - Current Salary ($):

Income - Spouse - Current Salary ($):

Income - Self - Bonus Income ($):

Income - Spouse - Bonus Income ($):

Income - Self - Other Income ($):

Income - Spouse - Other Income ($):

General

Do you plan to operate the business yourself?

Who will operate?

Do you intend to have a partner?

Who will your partner be?

Please describe how long you have been a certified personal trainer and name of the accreditation certification agency:

Do you have a preference as to the area or city where you would like to have your business located? - if so, where?

Why do you wish to purchase a franchise rather than becoming someone's employee or starting your own business?

If your request is approved, when would you like to open your business? (approx.)

How did you hear about us?

What professional goals have you set for future?

Location Preferences

State 1

State 2

State 3

City 1

City 2

City 3

Franchising Request for Consideration

Personal Information

Education

Present Employment

Prior Employment

Interests & Hobbies

Financial

Assets & Liabilities

Assets

Liabilities

General

Location Preferences

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