FRANCHISE APPLICATION

FRANCHISE APPLICATION FORM

This Application is kept confidential. Neither party is bound in any way by the submission of this Application. This Application must be completed in full and returned to receive further contact and information from Joe Beeverz. Please type or print clearly and attach additional documents or schedules, if necessary, to provide full disclosure.

Spouse's Name

Have you ever been convicted of a criminal offence or have any criminal charge pending or being appealed, or are you under indictment?

Please provide the required field.

If yes, please state details:

How did you become interested in a Joe Beeverz franchise and why?

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

Please provide the required field.

If yes, please give details:

Have you ever been involved in any litigation or arbitration/mediation with respect to your previous business history?

Please provide the required field.

If yes, please explain:

Will you work in the business full time?

Please provide the required field.

If no, please explain:

Who will be responsible for the day-to-day operations?

Will you have a business partner?

Please provide the required field.

If yes, please give name of each partner:

LOCATION PREFERENCES

May we contact your present employer?

Please provide the required field.

Name of Firm:

Address:

Type of Business:

Employed from and to:

Supervisor:

Telephone

Position:

Annual Compensation:

Duties and Responsibilities:

Name of Firm:

Address:

Type of Business:

Employed from and to:

Supervisor:

Telephone:

Position:

Annual Compensation:

Duties and Responsibilities:

Have you ever worked within the food service industry?

Please provide the required field.

If yes, when & where?

Describe any training in sales, management or retailing:

Have you ever been self-employed?

Please provide the required field.

If yes, explain

High School

Please provide the required field.

Others:

Post-Graduate

Please provide the required field.

Majors & Degree(s):

I make the following statement of all my assets and liabilities as of this

Cash on hand and unrestricted in the bank

Vested profit sharing/pension

Listed stocks/bonds/debentures

Notes/accounts/mortgage receivable

Real Estate

Other Assets

Total Assets

Accounts/Credit cards payable

Notes/Loans payable to banks, unsecured

Notes/Loans payable to banks, secured

Notes payable to others, secured and unsecured

Mortgages payable on Real Estate

Taxes and assessments payable

Other liabilities

Total Liabilities

Salary

Bonus

Dividends/Interest

Real Estate income

Business profits

Spousal income

Total Income

How will you finance this business venture?

What is the source of this Capital?

Face Value

Cost

Present Value

Last Yr Income

Face Value

Cost

Present Value

Last Yr Income

Description

Face Value

Cost

Present Value

Last Yr Income

Address

Registered Owner

Mortgagee

Cost

Present Value

Mortgage Owing

Address

Registered Owner

Mortgagee

Cost

Present Value

Mortgage Owing

Address

Registered Owner

Mortgagee

Cost

Present Value

Mortgage Owing

Name

Address

Occupation

Telephone

Name

Address

Occupation

Telephone

Name

Address

Occupation

Telephone

JOE BEEVERZ