Franchise Application Form

This information on this form is the basis for a franchise application and will be kept confidential. This form is not to be construed as an offer of a franchise, a commitment or a binding agreement on either party.

1. Personal Data

(Please complete the entire application form in order to be considered)

2. Personal History

3. Employment History

(Start with most recent employment and work backwards)

4. Educational History

(Please state the last year of education you completed.)

5. Applicant Profile

6. References

(excluding relatives)

7. Business Information

(Note: separate applications are required for each partner.)
%
If Yes, your business partners(s):

8. Location Preference

9. Financial Statement

(Mandatory information)
Assets
$
$
$
$
$
$
$
$
Liabilities
$
$
$
$
$
$
$
$

10. Please Read Carefully

I hereby certify that to the best of my knowledge and belief, the answers given by me to the foregoing questions and all statements made by me in this application are correct.

I hereby authorize Burrillos, or its agent, to verify any and all data submitted, and to make any additional credit and financial investigation that it deems necessary or advisable.

I hereby authorize Burrillos, or its agent, to obtain background character information regarding me which it deems necessary or advisable.

I understand that any false information or consequential omission contained in this application would be cause for immediate termination of any subsequent agreement reached between Burrillos and myself.

The undersigned cetify/ies that the information contained herein has been carefully read and is true and correct. (If your spouse is applying as a prospective co-franchisee, his/her signature is also require.)

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