First Name:
Last Name:
Address:
Phone:
E-Mail:
What attracted you to our business?
Please describe your professional background and job experience:
Have you ever owned a business?	No Yes
If yes, please explain:
Have you ever owned a franchise?	No Yes
If yes, please explain:
Are you currently employed?	No Yes
If yes, please describe your current occupation:
Have you ever declared bankruptcy?	No Yes
If yes, please explain:
Have you ever been convicted of a felony?	No Yes
If yes, please explain:
Financial Information
Assets:
Cash:
Stocks, bonds & mutual funds:
Real estate:
Other assets:
Liabilities:
Mortgages:
Credit card debt:
Other liabilities:
How much of your own money are you looking to invest?
Do you have access to additional capital?	No Yes
Do you have the minimum cash needed ($75,000)?	No Yes
Project Information
Where are you looking to open a Smoochies?
Do you have a site identified?	No Yes
Will you manage the store yourself?	No Yes
If no, please explain who will manage the business:
Are you exploring other franchises?	No Yes
If yes, in what categories?
Please provide any additional information: