FRANCHISE EVALUATION FORM
THIS IS NOT A CONTRACT AND SUPPLYING OR COMPLETING
Applicant's Name: Spouse: ---------------------------------------------------------------------------------------- Evaluation Date: ---------------------------------------------------------------------------------------- Home address: : how Long: ---------------------------------------------------------------------------------------- Previous address: how Long: ---------------------------------------------------------------------------------------- Home phone: work phone: ---------------------------------------------------------------------------------------- Occupation: ---------------------------------------------------------------------------------------- Name and ages of children: ---------------------------------------------------------------------------------------- Who will operate franchise? ---------------------------------------------------------------------------------------- Amount of Capital available? ---------------------------------------------------------------------------------------- Source of Capital: ---------------------------------------------------------------------------------------- Desired Region: Other Region: ---------------------------------------------------------------------------------------- U.S. Citizen or Permanent U.S. Resident?
THIS FORM INCURS NO OBLIGATION BY EITHER PARTYyes___ no___
---------------------------------------------------------------------------------------- Education and Degrees: ---------------------------------------------------------------------------------------- Previous Experience: ---------------------------------------------------------------------------------------- Have you ever filed bankruptcy? explain: ---------------------------------------------------------------------------------------- 'Social Security Number: ---------------------------------------------------------------------------------------- CONFIDENTIAL FINANCIAL STATEMENT ASSETS LlABlLITIES INCOME Cash In Bank Notes to Banks Self ---------------------------------------------------------------------------------------- Stocks/Bonds Notes to Others Spouse ---------------------------------------------------------------------------------------- Real Estate Mortgages on Real Estate interest ---------------------------------------------------------------------------------------- Automobiles Auto Loan Other Income ---------------------------------------------------------------------------------------- Other Assets Other Liabilities Other Income ---------------------------------------------------------------------------------------- The undersigned certifies that each, part of the evaluation and financial statements and the information inserted here has been carefully read and is true and correct. Signed: Date: