Franchise Application Form

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email Address*

Address*

Street Address

CityState / Province

Postal / Zip Code

PLEASE SELECT THAT APPLY*

CITIZENSHIPPERMANENT RESIDENTOTHERS(please specify below)

DATE OF BIRTH*

EMPLOYMENT HISTORY

POSITION *

COMPANY*

DATE OF EMPLOYMENT*

Date

RESON FOR LEAVING*

BUSINESS OWNERSHIP EXPERIENCE

TRADING NAME*

NATURE OF BUSINESS*

YEARS OF TRADE*

IS THE BUSINESS STILL OPERATING?*

YESNO

REFERENCES

COMPANY NAME *

CONTACT NAME*

Phone Number*

Area CodePhone Number

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.*

YESNO

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?*

YESNO

Been adjudged bankrupt or reorganized due to insolvency?*

YESNO

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 THE COMPANY?*

YESNO

Why do you think you will be successful?*

Are your intentions to work full time in the business?*

YESNO

Are you aware certain information provided and/or advised to you is confidential and shall not be divulged to any third person unless the company gives approval?*

YESNO

FINANCE INFORMATION(MONTHLY)*

	INCOME
SALARY 1
SHARES
INVESTMENT
OTHERS
TOTAL

FINANCE INFORMATION(MONTHLY)*

	EXPENCES
MORTAGE 1
CAR LOAN 1
CAR LOAN 2
CREDIT CARD 1
CREDIT CARD 2
GENERAL LIVING EXPENCES
OTHERS
TOTAL

HOW ARE YOU FUNDING THIS OPPORTUNITY?*

	MONTHLY REPAYMENT
CASH
HOME EQUITY
BUSINESS LOAN
OTHER
TOTAL

Al Hadi Franchise Form