CONFIDENTIAL FRANCHISE QUALIFICATION QUESTIONNAI RE

Please return application to:  Franklin Franchising, Inc.                  Date:                                  

                                                P.O. Box 744

                                                Sturtevant, WI 53177-0744

Or fax application to:                        262-681-6743

PERSONAL PROFILE

Name                                                                                                                               

Address                                                                                                                            

City                                                             State                Zip                                        

Home Phone                                    Business Phone                                                        

E-mail                                                                                                                              

Best Time & Place to Call You                                                                                        

Current Employment                                                                                                         

Date of Birth                          S/S #                        Drivers License #                              

Marital Status                        Name of Spouse                                                                  

Names & Ages of Children                                                                                                

Home (circle one): OWN    RENT  Are you willing to relocate for the right opportunity?
Y or  N

GENERAL INFORMATION
 

Are you a citizen of the U.S.A.?   Y  or  N    If not, what country?                                         

How did you hear about Ben Franklin’s Franchise Opportunity?                                            

Do you own or have you owned a business franchise in the past?   Y  or  N    If yes, please describe: 

Have you as an individual or a principal of a corporation ever been adjudicated as bankrupt?
 Y  or  N

Do you have or have you had Material Civil Action filed against you?  Y  or  N 

If selected as a Franchisee, would you plan to be: 

                                      An active “hands-on” owner

                                      Part-time owner (with other business interest)

                                      Passive owner

Do you plan on having a partner or other investors?  Y  or  N

If yes, please list names                                                                                             

Will your franchise investment come from your own capital?  Y  or   N
 

How much capital are you able to invest?                                                                     

AREA PREFERENCE

What area of the country would you have interest in for a franchise?                            

Specific communities:  City and State                                                                           

                                      City and State                                                                           

EXISTING BUSINESS RETAILER

Entity Name                                                                                                             

Entity Address                                                                                                          

Major Suppliers                                                        (2)                                             

Notification - Consent is hereby granted by the undersigned for the confirmation of existing business including but not limited to credit or Dunn & Bradstreet Report.

The completion of this Questionnaire is the first step in the Franchise Qualification process.  This is not a contract.  All Information provided will be held confidential.  No employer contact will be made without your prior approval.  It is understood that the purpose of this questionnaire is for general information for Franklin Franchise, Inc.  It is understood that the application supplies the information herein, to the best of his/her knowledge and ability and that Franklin Franchise, Inc. relies on this information in assessing the applicant.

Date                                                        Signature                                                 

FINANCIAL INFORMATION

The enclosed personal/business financial statement must be completed for our evaluation.  This can be accomplished at this time or at a later date when requested by Franklin Franchise, Inc.