| LADY BUG FRANCHISE CORPORATION |
| CONFIDENTIAL APPLICATION |
This application must be fully
completed in order to be accepted for
consideration
Please print or type Date
_______/______/_______
|
GENERAL INFORMATION
PRINCIPAL APPLICANT'S NAME
_____________________________________________________________________________
DATE OF BIRTH ______/_______/______
SOCIAL SECURITY NUMBER
__________________________________________
RESIDENCE ADDRESS
______________________________________________________________________________________
CITY___________________________________________________________
STATE ________________ ZIP______________
HOME PHONE (
______)___________________________
BEST TIME TO REACH
___________________________________
HOW LONG AT PRESENT ADDRESS
_____________________________________
OWN? __________ RENT? ________
PREVIOUS ADDRESS
_______________________________________________________________________________________
CITY___________________________________________________________
STATE ________________ ZIP______________
CURRENT
EMPLOYER_______________________________________________________________________________________
POSITION _______________________________
NATURE OF DUTIES
______________________________________________
EMPLOYER'S ADDRESS
_____________________________________________________________________________________
MAY WE CONTACT YOU AT WORK?
_________________________________________________________________________
BUSINESS PHONE (______ )
_______________________
BEST TIME TO REACH
___________________________________
EDUCATION
HIGH SCHOOL________ COLLEGE_________
DEGREE IN
___________________________________________________
HOBBIES AND INTERESTS
___________________________________________________________________________________
ATTACH RESUME IF AVAILABLE
IF HUSBAND/WIFE TEAM, IN WHAT POSITION
AND CAPACITY WILL SPOUSE BE INVOLVED?
_______________________________________________________________________________________________
SPOUSE'S NAME
___________________________________________________________________________________________
SPOUSE'S RESIDENCE ADDRESS
____________________________________________________________________________
SPOUSE'S HOME PHONE (
_____)__________________
BEST TIME TO REACH
___________________________________
SPOUSE'S CURRENT EMPLOYER
____________________________________________________________________________
POSITION _______________________________
NATURE OF DUTIES
______________________________________________
EMPLOYER'S ADDRESS
_____________________________________________________________________________________
MAY WE CONTACT YOU AT WORK?
_________________________________________________________________________
BUSINESS PHONE (______ )
_______________________
BEST TIME TO REACH
___________________________________
EDUCATION - SPOUSE
HIGH SCHOOL________ COLLEGE_________
DEGREE IN
___________________________________________________
HOBBIES AND INTERESTS
___________________________________________________________________________________
ATTACH RESUME IF AVAILABLE
GENERAL HEALTH
PRINCIPAL APPLICANT:
GOOD ______________________
FAIR________________ POOR
_________________
BACK PROBLEMS?____________________
VISION PROBLEMS? _________________
SPOUSE:
GOOD ______________________
FAIR________________ POOR
_________________
BACK PROBLEMS?____________________
VISION PROBLEMS? _________________
DEPENDENTS
NAMES AND AGES OF CHILDREN
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
OTHER DEPENDENTS?______________________
RELATIONSHIPS AND AGES
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
WILL YOU HAVE A PARTNER OR OTHER
PARTNERS OTHER THAN YOUR SPOUSE?
_____________________________
IF YES, WHAT WILL BE THEIR INVOLVEMENT?
_______________________________________________________________
_______________________________________________________________
PLEASE HAVE THEM FILL OUT A SEPARATE
APPLICATION
DO YOU OR YOUR SPOUSE (IF CO-APPLICANT)
HAVE ANY FELONY CHARGES PENDING, BEING
APPEALED, OR ARE YOU UNDER INDICTMENT?
______________________________________________________________________
FINANCIAL INFORMATION
PRESENT ANNUAL INCOME
______________________________________________________________________
SPOUSE'S PRESENT ANNUAL
______________________________________________________________________
INCOME INTEREST AND DIVIDENDS
______________________________________________________________________
OTHER INCOME
______________________________________________________________________
TOTAL INCOME
______________________________________________________________________
ATTACH PREPARED FINANCIAL STATEMENT, IF
AVAILABLE
YOUR BANK
_______________________________________________________________________________________________
BANK PHONE
(_______)______________________
BANK OFFICER
______________________________________________
CHECKING ACCOUNT
NO.____________________________
SAVINGS ACCOUNT
NO.______________________________
DO YOU OWN YOUR OWN HOME?
________________________________________
DO YOU OWN YOUR OWN BUSINESS?
________________________________________
HAVE YOU EVER FILED FOR PERSONAL OR
BUSINESS BANKRUPTCY?
_________________________________________
HAVE YOU EVER HAD ANYTHING REPOSSESSED?
____________________________________________________________
HOW DO YOU PLAN TO PAY FOR THE INITIAL
FRANCHISE FEE?
_______________________________________________
WHAT IS YOUR CUSTOMARY EARNINGS
LEVEL?_________________________
SPOUSE'S?_________________________
ESTIMATED MINIMUM INCOME REQUIRED FOR
YOUR CURRENT LIVING EXPENSES?
___________________________
ASSETS LIABILITIES
CASH IN
CHECKING_______________________________
NOTES PAYABLE TO BANKS
____________________________
CASH IN SAVINGS
________________________________
NOTES PAYABLE TO OTHERS
___________________________
REAL ESTATE
(HOME)_____________________________
REAL ESTATE DEBT
____________________________________
OTHER REAL
ESTATE_____________________________
AUTOMOBILE DEBT
____________________________________
(DESCRIBE)
________________________________________________________________________________________________
___________________________________________________________________________________________________________
OTHER ASSETS OTHER LIABILITIES
CASH SURRENDER OF LIFE
INS.___________________
OWING ON LIFE INSURANCE
____________________________
STOCKS AND
BONDS______________________________
TAXES PAYABLE
_______________________________________
AUTOMOBILES
___________________________________
CHARGE
ACCOUNT_____________________________________
YOUR OWN
BUSINESS_____________________________
OTHER
LIABILITIES_____________________________________
APPRAISED COLLECTIBLES
_________________________________________________________________________________
MONEY DUE YOU
__________________________________________________________________________________________
OTHER ASSETS (DESCRIBE)
_________________________________________________________________________________
TOTAL ASSETS
$__________________________________
LESS TOTAL LIABILITIES
$__________________________________
NET WORTH
$__________________________________
EXACT AMOUNT OF CAPITAL YOU HAVE FOR
THIS FRANCHISE
$______________________________________________
IF THE REQUIRED AMOUNT IS NOT AVAILABLE,
HOW WOULD THE INVESTMENT BE OBTAINED?
PLEASE EXPLAIN IN DETAIL:
________________________________________________________________________
___________________________________________________________________________________________________________
HAVE YOU EVER BEEN A PRINCIPAL OWNER OF
A BUSINESS BEFORE?
________________________________________
IF YES, BRIEFLY EXPLAIN
__________________________________________________________________________________
___________________________________________________________________________________________________________
LEGAL FORMAT
( ) SOLE PROPRIETOR NAME
________________________________________________________________________
( ) CORPORATION NAME
________________________________________________________________________
( ) PARTNERSHIP NAME
________________________________________________________________________
( ) OTHER NAME
________________________________________________________________________
EXPLAIN
______________________________________________________________________
HAVE YOU EVER BEEN A PRINCIPAL OWNER OF
A BUSINESS BEFORE?
________________________________________
IF YES, BRIEFLY EXPLAIN
__________________________________________________________________________________
___________________________________________________________________________________________________________
HAVE YOU EVER BEEN GRANTED A FRANCHISE
OR LICENSE BEFORE?
________________________________________
IF YES, BRIEFLY EXPLAIN
__________________________________________________________________________________
___________________________________________________________________________________________________________
HAVE YOU EVER BEEN OR ARE YOU CURRENTLY
INVOLVED IN LITIGATION?
__________________________________
IF YES, BRIEFLY EXPLAIN
__________________________________________________________________________________
___________________________________________________________________________________________________________
LOCATION
DO YOU HAVE A TERRITORY IN MIND ALREADY?
Yes ______ No _____
IF SO, IN WHAT CITY AND, IF KNOWN, WITH
ZIP CODE?
_______________________________________________________
REFERENCES
I HEREBY AUTHORIZE Lady Bug Franchise
Corp. TO CONTACT THE FOLLOWING
REFERENCES AND OTHER SOURCES FOR
INFORMATION ABOUT ME. I RELEASE Lady Bug
Franchise Corp. ,ITS AFFILIATES, AGENTS
AND EMPLOYEES FROM ANY LIABILITY ARISING
EITHER FROM THE RECEIPT OR USE OF ANY
INFORMATION OBTAINED THROUGH THESE
SOURCES.
CREDIT REFERENCES
BUSINESS REFERENCES
PERSONAL REFERENCES
|
1.
NAME________________________________________
ADDRESS_____________________________________
CITY,
STATE__________________________________
PHONE
_______________________________________ |
1.
NAME________________________________________
ADDRESS_____________________________________
CITY,
STATE__________________________________
PHONE
_______________________________________ |
2.
NAME________________________________________
ADDRESS_____________________________________
CITY,
STATE__________________________________
PHONE
_______________________________________ |
2.
NAME________________________________________
ADDRESS_____________________________________
CITY,
STATE__________________________________
PHONE
_______________________________________ |
3.
NAME________________________________________
ADDRESS_____________________________________
CITY,
STATE__________________________________
PHONE
_______________________________________ |
3.
NAME________________________________________
ADDRESS_____________________________________
CITY,
STATE__________________________________
PHONE
_______________________________________ |
|
|
SUCCESS INDICATORS
DO YOU ENJOY AND GET ALONG WELL WITH
PEOPLE?
_______________________________________________________
DO YOU HAVE A BACKGROUND IN SALES?
___________________________________________________________________
CAN YOU FEEL COMFORTABLE IN
PRESENTING A SERVICE IN WHICH YOU
BELIEVE?
___________________________
ARE YOU A SELF MOTIVATOR?
_____________________________________________________________________________
WILL YOU BE WILLING TO SHARE SOME OF
YOUR BUSINESS EXPERIENCES OF YOUR
FRANCHISE WITH OTHER LADY BUG
FRANCHISEES?
___________________________________________________________________
ARE YOU WILLING TO FOLLOW A PLAN TO
MAKE YOUR BUSINESS SUCCESSFUL?
_____________________________
IF WE WERE TO GO AHEAD, WHAT WOULD
BE YOUR SCHEDULE FOR STARTING?
______________________________
WHY DO YOU THINK YOU WOULD ENJOY AND
DO WELL IN THIS BUSINESS?
___________________________________
APPLICATION STATEMENT
IT IS UNDERSTOOD THAT THE PURPOSE OF
THIS APPLICATION IS FOR INFORMATION
ONLY, AND IS NO WAY BINDING UPON
EITHER LADY BUG FRANCHISE
CORPORATION OR THE APPLICANT.
THE INFORMATION I HAVE SUBMITTED
WITHIN THIS APPLICATION IS TRUE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE
AND BELIEF.
I CERTIFY I AM NOT, NOR TO THE BEST
OF MY KNOWLEDGE, BEEN DESIGNATED A
SUSPECTED TERRORIST AS DEFINED IN
EXECUTIVE ORDER 13224.
SIGNATURE OF APPLICANT
_________________________________________________________
DATE _____ / ____ / ____
|
Mail to:
Lady Bug Franchise Corporation
1641 E University Drive
Mesa, Arizona 85271 |
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