Franchise Interest Form

CONFIDENTIAL INFORMATION. Please complete this franchise interest form electronically and submit it below automatically to [email protected].

"*" indicates required fields

SECTION 1: PERSONAL DATA

Name*

First Last

Date of Birth*

Marital Status

Spouse’s Name

Date of Birth

Number of Children

Total Dependents

Home Address*

Years There*

Country*

City*

State*

Postal / Zip Code*

Phone / Mobile*

Email*

SECTION 2: EDUCATION

High School

University / College

Degree

Describe any training

SECTION 3: BUSINESS EXPERIENCE

Present Occupation*

Company

Address

Salary

Duties/Responsibilities

Spouse's Occupation

Company

Address

Salary

Are you now self-employed?

Yes

Firm

Phone Number

Type of business

Years in business

Your Title

Yearly Sales

Salary

SECTION 4: PREVIOUS BUSINESS EXPERIENCE

Position

Company

Position

Company

Position

Company

SECTION 5: FINANCIAL

ASSETS

Cash ($)*

Stocks, Bonds & Securities ($)*

Accts, Notes Receivable ($)*

Real Estate (Market Value) ($)*

Automobiles (Market value) ($)*

Cash value – Life Insurance ($)*

Retirement Savings plan ($)*

Other assets ($)*

TOTAL ASSETS ($)

RELIABILITIES

Unpaid Taxes ($)*

Loans ($)*

Other Bank Loans ($)*

Mortgage Loan Owing($)*

Other Liabilities ($)*

TOTAL LIABILITIES ($)

SECTION 6: ABOUT YOU

From what source did you learn about FRESH – Healthy Cafe?*

Are you seeking an individual franchise or multiple units?*

Print Name*

Date*

Save or Print a Copy

Phone

This field is for validation purposes and should be left unchanged.

SECTION 1: PERSONAL DATA

SECTION 2: EDUCATION

SECTION 3: BUSINESS EXPERIENCE

SECTION 4: PREVIOUS BUSINESS EXPERIENCE

SECTION 5: FINANCIAL

ASSETS

RELIABILITIES

SECTION 6: ABOUT YOU

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