Part I. General Information

Date:
Name:
Address:
City:   State: Zip:

Home Phone:
Business Phone:

If necessary, may we contact you at your place of business?   Yes No
Best time to contact you   (a.m.) (p.m.)

Desired area for franchise (city and state)

Second choice of location (city and state)
Would you have a partner in your franchising venture?  Yes No

If so, could you name the individual and state your relationship to this person?

Part II. Education

Please tell us a little about your educational background.
High School: (name) Graduate Yes No
College (name) Degree

Graduate school/special training (please describe)

Part III. Employment History

Please use the spaces below to list employment history within the past five years, or three positions held, starting with most current position.

1.

2.

3.

Part V.  Other
Have you ever owned or do you presently own a business?  Yes No

If so, please give details.

Part VI.

Anything about yourself that you’d like to tell us (outside interests, organizations, hobbies)

Can we contact you to discuss the franchising opportunity? Yes No

Best way to reach you?
(Phone)   (E-mail)