form page - Tapioca Express

Franchise Application Form

PERSONAL INFORMATION

First name *

Last name *

E-mail *

Address *

State/Region *

City *

Zip Code *

Mobile phone number *

Home Phone

Fax number

PRE-QUALIFICATION DATA

Are you US citizen? *

If not, what is your immigration status?

Have you ever been convicted of a felony or misdemeanor or are such charges pending or being appealed or are you under indictment (minor traffic violations are not included)? *

Have you ever been adjudicated bankrupt?*

Do you have a minimum of $160,000 liquid assets to begin financing this franchise venture? *

Are you or is your employer providing products, goods or services to Tapioca Express or any of its franchisees?*

BUSINESS EXPERIENCE

(Work history and/or business started. Please give present or most recent position first)

Company Name

Position/Title

Annual Salary

Type of Business

Company Street

Company City *

Company State *

Company Zip Code

Date Employed

Telephone Number

Company Website

Briefly describe your duties and responsibilities at work

May we contact your current employer?

Company Name 2

Position/Title 2

Annual Salary 2

Type of Business 2

Company Street 2

Company City 2

Company State 2

Company Zip Code 2

Date Employed 2

Telephone Number 2

Company Website 2

Briefly describe your duties and responsibilities at work 2

EDUCATION

Name of School

School Last Attended

Degrees/Certifications Obtained *

BUSINESS INTEREST

What percentage of the equity of this business will you own?*

What amount of cash will you personally invest in this business?*

What is the source of funding for your investment? (e.g. savings, stocks, real estate, or loan, etc.)*

How actively involved would you be in the day-to-day operations of this business?*

Will you have a business partner(s)? (If YES, please have partner(s) fill a separate application)*

If you have a business partner(s), who will be the operating partner?*

Are you going to be the manager of your future store?*

If you answer “No”, Please fill out the name who will be the manager of your store

What is the total amount your business partner(s) will invest in this business?*

Do you currently have a location? (If YES, write address below)*

Location Address*