Franchise Application Form

This information of this form is the basis for a franchise application and will be kept confidential. This form is not to be construed as an offer of a franchise, a commitment or a binding agreement on either party.

Personal Data

First Name: *

Surname: *

Date of birth: *

Social Insurance/Security Number: *

Unit & street address: *

City: *

Province/State: *

Postal/Zip code: *

Home phone: *

Work phone: *

Cell phone: *

Best number to contact you: *

Fax (If any):

E-mail: *

Do you rent or own your home?: *

How many years at this location?: *

Marital status: *

Will your spouse be active in the business?:

Spouse/partner's name:

Spouse/partner's occupation:

(Please complete the entire application form in order to be considered.)

Personal History

What is your citizenship?: *

American or Other (please specify)

If "Other" what is your country of permanent residence:

If "Other" what is your current immigration status:

Have you ever owned your own business before?: *

Details:

Are you currently a party to any pending legal action?: *

If "Yes" please give details:

Have you ever been convicted of an offense under the laws of P.Rico or the USA for which a pardon has not been granted?: *

If "Yes" please give details:

Have you ever been adjudicated bankrupt?: *

if "Yes" please give date & details:

Employment History

Company: *

Type of business: *

Address: *

Start date: *

End date: *

Position: *

Annual salary: *

Supervisor: *

Phone: *

Duties, responsabilities, number of employees supervised etc.: *

Company:

Type of business:

Address:

Start date:

End date:

Position:

Annual salary:

Supervisor:

Phone:

Duties, responsabilities, number of employees supervised etc.:

Company:

Type of business:

Address:

Start date:

End date:

Position:

Annual salary:

Supervisor:

Phone:

Duties, responsabilities, number of employees supervised etc.:

May we contact your past employers?:

(Start with most recent employment and work backwards.)

Education History

High school: *

College/University:

Degree or diploma completed:

Training in sales, management or retail:

Other:

(Please state the last year of education you completed.)

Applicant Profile

What appeals to you about franchising?: *

How would you describe the roles of the Franchisor (e.g. Vanessa´s Coffee Shop and the Franchisee?): *

How did you become interested in a Vanessa's Coffee Shop franchise --- and why?: *

Have you been to a Vanessa's Coffee Shop store?: *

If "Yes", which location?:

What appeals to you about a Vanessa's Coffee Shop franchise?: *

Have you ever owned or had an interest in any other operation within the food service industry?:

If "Yes", please give details:

How many hours do you typically work per week?: *

How many hours would you like to work per week?: *

Who would be responsible for the franchise's day-to-day operation?: *

In your opinion, what are the characteristics of a good business?: *

If you were awarded a franchise, what would you do to make the business successful?: *

What are your goals/objectives for the next 5 years?: *

References

Name and relationship: *

City, Province/State: *

Phone: *

Name and relationship:

City, Province/State:

Phone:

Name and relationship:

City, Province/State:

Phone:

Business Information

What percentage of the equity of the restaurant will you own?: *

Will you have a business partner or partners?: *

Name: *

Participation: *

Name:

Participation:

Name:

Participation:

What other business(es) do you have an interest in?: *

How do you plan to finance this business venture?: *

If Loan, what collateral will you make available?: *

If qualified, when would you be ready to invest in your franchise?: *

Will you require assistance in obtaining financing?: *

(Note: separate applications are required for each partner.)

Location Preference

First choice: *

Second choice: *

Other(s): *

Would you be willing to relocate?: *

If "Yes", where?:

Financial Statement

Personal financial information as of today (enter today's date): *

ASSETS

Cash on hand: *

Securities: *

(stocks, bonds, RRSPs, IRAs)

Accounts and loans: *

(receivables)

Home: *

(market value)

Other real estate: *

Automobiles: *

(market value)

LIABILITIES

Other assets: *

(please list)

Notes payable: *

Loans against insurance: *

Loans: *

Mortgages: *

(balance owing)

Credit cards: *

Other liabilities: *

(please list)

(mandatory information)

PLEASE READ CAREFULLY

I hereby certify that to the best of my knowledge and belief, the answers given by me to the foregoing questions and all statements made by me in this application are correct.

I hereby authorize Vanessa's Coffee Shop, or its agent, to verify any and all data submitted, and to make any additional credit and financial investigation that it deems necessary or advisable.

I hereby authorize Vanessa's Coffee Shop or its agent, to obtain background character information regarding me which it deems necessary or advisable.

I understand that any false information or consequential omission contained in this application would be cause for immediate termination of any subsequent agreement reached between Vanessa's Coffee Shop and myself.

The undersigned certify/ies that the information contained herein has been carefully read and is true and correct. (If your spouse is applying as a prospective co-franchisee, his/her signature is also required.)

Date: *

Signature: *

Write your full name. This field will have the same validity as if it were your signature.

Signature (spouse): *

Write your full name. This field will have the same validity as if it were your signature.

I agree that this field will be the electronic representation of my signature and has the same legal validity as a handwritten signature: *

Franchise Application Form

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