Step 1

Personal Details

Current Address

Telephone Numbers

Own
Rent
Other

Previous Address if less than 5 years

Areas of Interest

Yes
No
May be

Step 2

Business / Work Experience

Current Company

Previous Company

Previous Company

Yes
No

Step 3

Education

High School

Step 4

Additional Information

Yes
No
Yes
No
Yes
No

Step 5

Personal Financial Statement

ASSETS - List and Describe all Assets Amount (In $)
Cash on Hand and in Banks (give details on Schedule 4)
Accounts, Loans and Notes Receivable (give details on Schedule 1)
Marketable Securities, Stocks and Bonds, Non Registered (give details on Schedule 2A)
Retirement Accounts i.e. Registered Retirement Savings Plan (give details on Schedule 2B)
Other Retirement Accounts (give details on Schedule 2C)
Real Estate Owned (give details on Schedule 3)
Real Estate Mortgages Receivable
Automobile(s)
Other Assets (e.g. value of existing businesses)
Total Assets
LIABILITIES - List and Describe all Liabilities Balance Owing (In $) Monthly Payment (In $)
Bank Loans
Amounts Payable to Friends and Relatives (include alimony and child support)
Credit Cards (please itemize)
Mortgages on Real Estate Owned (give details on Schedule 3)
Unpaid Income Tax and Other Taxes and Interest
Other Debts (please itemize)
TOTAL MONTHLY PAYMENTS
TOTAL LIABILITIES
NET WORTH (TOTAL ASSETS - TOTAL LIABILITIES)
Applicant's Salary
Spouse's Salary
Bonus & Commissions
Dividends
Net Real Estate Income
Other Income
Total Annual Income

Step 6

Schedule

Accounts, Loans and Notes Receivable - Schedule 1
Name & Address of Debtor Amount Owing Age of Debt Description and Nature of Debt Description and Security Held Date Payment Expected
Marketable Securities, Stocks and Bonds, Non-Registered - Schedule 2A
Number of Units & Shares Description of Security Registered to (Name of Brokerage) Where Quoted or Listed Present Market Value and Date Income Received Last Year Pledged as Collateral
Retirement Accounts i.e. Registered Retirement Savings Plan - Schedule 2B
Number of Units & Shares Description of Security Registered to (Name of Brokerage) Where Quoted or Listed Present Market Value and Date Income Received Last Year Pledged as Collateral
Other Retirement Accounts - Schedule 2C Provide Copies of Most Recent Statements
Number of Units & Shares Description of Security Registered to (Name of Brokerage) Where Quoted or Listed Present Market Value and Date Income Received Last Year Pledged as Collateral
Real Estate Owned - Schedule 3
Property Address (Primary) Type of Property Amount of Mortgage Monthly Mortgage Payment Monthly Taxes, Insurance Maintenance and Misc. Net Monthly Cost
First Mortgagee Name & Address Title in Name of First Mortgage
Second Martgage
First Mortgage
Second Mortgage
Second Mortgagee Name & Address Month & Year Acquired Purchase Price Current Market Value
Property Address (Other) Type of Property Amount of Mortgage Monthly Mortgage Payment Monthly Taxes, Insurance Maintenance and Misc. Net Monthly Cost
First Mortgagee Name & Address Title in Name of First Mortgage
Second Martgage
First Mortgage
Second Mortgage
Second Mortgagee Name & Address Month & Year Acquired Purchase Price Current Market Value
Provide names of banks, trust or finance companies where accounts are carried or where credit can be obtained - Schedule 4
Name and Location of Banks Cash Balance Outstanding Loans Loan Maturity of or Secured How Endorsed Guaranteed
References
Name Address and Telephone Position/Relationship
Yes
No
Yes
No
Yes
No
Yes
No

The federal government has deemed that information gathered from an individual by a corporation is considered confidential and may not be used for any purpose unless approval has been granted by that individual. Your signature on this form indicates approval for the use of the information provided for our own internal use only.

For the purpose of securing credit and other considerations, the undersigned furnished the foregoing statement and information which fully and truly sets forth the true and accurate financial conditions of the applicant. The undersigned agrees to notify the Franchisor in writing of an y changes in its financial condition. The undersigned agrees that a report as to credit and other information is to be obtained for credit now applied for and consents to the disclosure of any such information to any credit grantor or consumer reporting agency with whom we and/or the applicant may transact.

This information will be kept on file for a period of three (3) years at which time paper copies will be destroyed and a new and updated application required. Name, address and telephone numbers will be kept on electronic file for statistical purposes only.

The applicant acknowledges that the Franchisor has many criteria for accepting a franchisee, and reserves the right to reject any applicant without itemizing the reasons for such rejection.