FRANCHISE APPLICATION FORM – CONFIDENTIAL

Name: *

First

Middle

Last

Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email: *

Home Phone: *

Cell Phone: *

Current Job Title:

Current Salary $: *

GENERAL INFORMATION / EXPERIENCE

Have you ever been a business owner? (If yes, please describe):

Have you ever supervised two or more employees?: *

Yes
No

How many years of management experience do you have?: *

How many years of customer experience do you have?: *

What is the highest level of education you have completed? : *

Will you have a partner in this business?: *

Yes
No

Will your partner be active? *

Yes
No

Which franchise area are you interested in?: *

Are you a home owner?: *

Yes
No

Do you own other real estate?: *

Yes
No

If so what type of real estate do you own?:

Have you or a spouse ever filed for bankruptcy?: *

Yes
No

If yes, why?:

Are you a Canadian Citizen?: *

Yes
No

If no, what is your resident status?:

Have you ever been convicted of an indictable offence?: *

Yes
No

FINANCIAL INFORMATION

Estimate capital to invest: $ *

Estimate net worth (assets less liability): $ *

Current household income (you and your spouse combined): *

Income Range *

Statement of Financial Condition (List amounts only) :

ASSETS

Cash in hand/or in bank: $ *

Stocks & Bonds: $ *

Gov’t & Marketable Securities: $ *

RRSP’s: $ *

Home-Value: $ *

Other Real Estate Value: $ *

TOTAL ASSET VALUE: $ *

LIABILITIES

Notes Payable to Banks: $

Notes Payable to Others: $

Credit Card Debt: $

Loans: $

Mortgage Payable: $

Other Mortgage Payable: $

TOTAL LIABILITIES VALUE: $ *

NET WORTH (total Assets minus Liabilities: = $ *

Disclosure and Authorization

Agreement *

I attest that the information provided herein is true and correct to the best of my knowledge. I understand that Karahi Point Restaurants may utilize the services of a consumer reporting agency to verify the information I have provided in the Preliminary Financial Information to evaluate my qualifications as a franchise applicant. I understand the investigation may include obtaining information regarding my creditworthiness, character, general reputation, personal characteristics, or mode of living and will be obtained for the purpose of evaluating my qualifications and verifying the information contained in the personal and financial section. I hereby authorize Karahi Point Restaurant to obtain a consumer report or make other inquiries about the information described herein and I hereby release Karahi Point its employees, representatives and agents from any liability as a result of the reporting of such information.

Print Name:

Date / Time *

Print Name: (partner-optional)

Date / Time ((partner-optional)