FRANCHISE APPLICATION FORM

FRANCHISE APPLICATION FORM

STRICTLY CONFIDENTIAL
ATTENTION : FRANCHISING DEPARTMENT

EMAIL TO franchise@coucoucoffee.com
Do you have any preferred locations in mind for opening a COUCOU chain
Where is the new location for your COUCOU?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Why did you choose there？
APPLICANT INFO

We prioritize the security of your personal information. Application details will be handled with strict confidentiality, following our privacy policy.
APPLICANT 1
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
Address

Street Address

CityState / Province

Postal / Zip Code
PLEASE SELECT THAT APPLY
DATE OF BIRTH
EMPLOYMENT HISTORY
POSITION
COMPANY
DATE OF EMPLOYMENT
FROM (MONTH/YEAR) TO(MONTH/YEAR)
RESON FOR LEAVING
BUSINESS OWNERSHIP EXPERIENCE (if applicable)
TRADING NAME
NATURE OF BUSINESS
YEARS OF TRADE
IS THE BUSINESS STILL OPERATING?
TRADING NAME
NATURE OF BUSINESS
YEARS OF TRADE
IS THE BUSINESS STILL OPERATING?
REFERENCES
COMPANY NAME
CONTACT NAME
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
COMPANY NAME
CONTACT NAME
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
OTHER BACKGROUND INFORMATION Have you or any applicable partners, officers, directors, or shareholders with your business affiliations ever:
Had any administrative, criminal or civil action alleging a violation of any franchise law, fraud, embezzlement, fraudulent conversation, restraint of trade, unfair or deceptive practices, and misappropriation of property or comparable allegations? Please note that FISHWAVE reserves the right to request a copy of your criminal record from the relevant State Police Authority.
Been convicted of a felony or pleaded “no contest” to a felony charge or been held liable in a civil action by a final judgement or been the subject of a material complaint or other legal proceeding such as a felony, civil action complaint, misappropriation of property or comparable allegations?
Been adjudged bankrupt or reorganized due to insolvency?
If you answered “Yes” to any of the questions above, please explain:
GENERAL INQUIRY
ARE YOU PREPARE TO COMPLY WITH THE PROCEDURES AND CONTROLS SET BY COUCOU?
Why do you think you will be successful?
Are your intentions to work full time in the business?
Are you aware certain information provided and/or advised to you is confidential and shall not be divulged to any third person unless COUCOU gives approval?

HOW ARE YOU FUNDING THIS OPPERTUNITY?

Rows	MONTHLY REPAYMENT
CASH
HOME EQUITY
BUSINESS LOAN
OTHER
TOTAL

Acknowledgment & Authorisation

All information contained herein is confidential and is strictly for the purpose of facilitating the COUCOU franchise application process. COUCOU is not a party to this sale of business transaction and makes no representation of warranty as to the accuracy or completeness of the information provided. Any information or comments provided to you do not constitute financial advice. COUCOU cannot estimate earnings for franchised business and does not make forecasts or projections. The submission of this application does not obligate either the applicant or COUCOU in any manner, nor does it imply that there is a legal or commercial relationship between either party. COUCOU reserves the sole right to approve or disapprove the application for any reason it may determine, and in the event that COUCOU disapproves the application, it shall have no liability to the undersigned. It is merely a preliminary procedure. Acknowledgement is made that the information supplied by me is true and correct. I hereby authorize COUCOU to obtain any information about my credit history or other information that it deems appropriate to evaluate my suitability as a prospective COUCOU Franchisee.
Declaration for Mail, Emailed and Faxed Applications
I/WE
OF(ADDRESS)
1. I/We have answered the questions and provided the information in this form to the best of my/our knowledge and belief, and that as far as I am/we are aware the answers and information are true and correct in all respects and that no relevant details have been omitted.2. I/We acknowledge that if any information included in this Application is false or misleading in anyway COUCOU shall have the right to terminate any franchise agreement entered into on the basis of the information contained in this Application I/We also acknowledge and agree that COUCOU: 1. Is collecting the information contained in this Application to assess whether I/we should beconsidered as a potential franchisee;2. Is relying upon the information contained in this Application as a material factors in considering this Application3. Is authorised to contact any appropriate third parties to verify the accuracy of the information in the application, and to retain any information obtained for its records;4. May provide the information contained in this Application to its advisors, including its accountants, lawyers and consultants; and5. May retain copies of this Application for its records, whether or not this Application is successful
Dated this

MonthDayYear
Date
For Electronic Applications:By submitting this application electronically, I agree to the above statements.
APPLICANT 1 Signature
APPLICANT 2 Signature
Should be Empty:

FRANCHISE APPLICATION FORM

ATTENTION : FRANCHISING DEPARTMENT

APPLICANT INFO

Acknowledgment & Authorisation