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Agent Application

We serve a multicultural clientele of diverse backgrounds, tastes and incomes. A typical GRANO COFFEE shop is between 400 - 1,800 sq feet, with a customer flow of 200 - 270 checks per day. Interested in a franchisee opportunity?

BUSINESS DEVELOPMENT AGENT APPLICATION FORM

PLEASE ANSWER ALL QUESTIONS
WRITE CLEARLY OR PRINT

Step 1 : PERSONAL INFORMATION

* FIRST NAME
MIDDLE NAME
* LAST NAME
* DATE OF APPLICATION
/ /
* BIRTHDATE
/ /
AGE
* TELEPHONE NUMBER
( )

CURRENT ADDRESS CITY COUNTRY

HOW LONG?

PREVIOUS ADDRESS CITY COUNTRY

HOW LONG?
WEIGHT
SINGLE
MARRIED
WIDOWED
FULL NAME OF SPOUSE
OCCUPATION OF SPOUSE
NAMES AND AGES OF DEPENDENT CHILDREN
Next

Step 2 : APPLICANT`S FRANCHISE PLANS

WILL THE FRANCHISE BE OWNED AND OPERATED BY YOURSELF OR A GROUP?
AMOUNT OF CAPITAL AVAILABLE FOR THIS BUSINESS
 
TERRITORY FOR WHICH APPLICATION MADE
WOULD YOU CONSIDER ANY OTHER AREA?
WHAT AREA(S)?
Next

Step 3 : EDUCATION

PLEASE LIST ALL EDUCATION YOU HAVE RECEIVED INCLUDING HIGH SCHOOL, COLLEGE, MILITARY OR SPECIAL TRAINING.

NAME OF SCHOOL
DATES OF ATTENDANCE
/ / TO  / /
MAJOR AND MINOR FIELDS
% OF EXPENSES EARNED
LOCATION OF SCHOOL
GRADE AVERAGE OR CLASS STANDING
DIPLOMA OR DEGREE
DATE OF GRADUATION
NAME OF SCHOOL
DATES OF ATTENDANCE
/ / TO  / /
MAJOR AND MINOR FIELDS
% OF EXPENSES EARNED
LOCATION OF SCHOOL
GRADE AVERAGE OR CLASS STANDING
DIPLOMA OR DEGREE
DATE OF GRADUATION
Next

Step 4 : BUSINESS AND EXPERIENCE RECORD

GIVE A COMPLETE RECORD OF YOUR EXPERIENCE, BEGINNING WITH YOUR PRESENT OR LAST POSITION, INCLUDE MILITARY SERVICE, INDICATE BY ASTERISK (*) THOSE EMPLOYERS YOU DO NOT WISH US TO CONTACT.

HAVE YOU BEEN IN BUSINESS FOR YOURSELF
NAME AND ADDRESS OF EMPLOYER
POSITION, TITLE AND DUTIES
DATES OF EMPLOYMENT FROM
/ / TO / /
SUPERVISOR’S NAME AND TITLE
REASON FOR SEPARATION
BEGINNING SALARY
ENDING SALARY
NAME AND ADDRESS OF EMPLOYER
POSITION, TITLE AND DUTIES
DATES OF EMPLOYMENT
FROM / / TO / /
SUPERVISOR’S NAME AND TITLE
REASON FOR SEPARATION
BEGINNING SALARY
ENDING SALARY
NAME AND ADDRESS OF EMPLOYER
POSITION, TITLE AND DUTIES
DATES OF EMPLOYMENT
FROM / / TO / /
SUPERVISOR’S NAME AND TITLE
REASON FOR SEPARATION
BEGINNING SALARY
ENDING SALARY
Next

Step 5 : PHYSICAL CONDITION INCOME

GENERAL PHYSICAL CONDITION
DATE OF LAST PHYSICAL EXAM
/ /
YEAR
EARNED (salary, commissions, fees, etc.) $
INTEREST & DIVIDENDS RECEIVED $
RENTS RECEIVED $
OTHER INCOME
$
$
$
GROSS INCOME $
LIST ANY PHYSICAL IMPAIRMENTS OR CHRONIC ILLNESSES WHICH MAY PRECLUDE CERTAIN TYPES OF ACTIVITIES
Next

Step 6 : REFERENCES

PLEASE LIST THREE PROFESSIONAL AND CHARACTER REFERENCES – NAME-ADDRESS-TELEPHONE
1.
2.
3.
LIST THREE CREDIT REFERENCES-NAME-ADDRESS-TELEPHONE
1.
2.
3.
BANK REFERENCES-NAME-ADDRESS           CHECKING ACCOUNT      Z       SAVINGS ACCOUNT   Z       OTHER   Z
Next

Step 7 : CONTINGENCIES

Do you have any contingent liabilities? If so, please itemize
Are any of your assets pledged? If so, please itemize
Are you a defendant in any lawsuits or legal actions?
Have you ever taken bankruptcy?
Next

Step 8 : CONFIDENTIAL FINANCIAL STATEMENT

NAME DATE: , 20

(PLEASE ANSWER ALL QUESTIONS USING "NO" OR "NONE" WHERE NECESSARY)

ASSETS

 

LIABILITIES AND NET WORTH

 
Cash (See Sched. No. 1) On hand, and unrestricted in banks. $ Notes Payable to Banks. Unsecured Direct Borrowings only.
(See Sched. No. 1)
$
    Notes Payable to Banks. Secured Direct Borrowings only
(See Sched. No. 1)
Accounts and Loans Receivable
(See Sched. No. 2)
Notes Receivable, Discounted with Banks, Finance Companies, etc.
(See Sched. No. 1)
Notes Receivable, Not Discounted
(See Sched. No. 2)
Notes Payable to Other, Unsecured
Life Insurance, Cash Surrender Value (Do not deduct loans)
(See Sched. No. 3)
Loans Against Life Insurance
(See Sched. No. 3)
Other Stocks and Bonds
(See Sched. No. 4)
Accounts Payable
Real Estate
(See Sched. No. 5)
Interest Payable
Automobiles Registered in Own Name Taxes and Assessments Payable
(See Sched. No. 5)
Other Assets
(Itemize)
Mortgages Payable on Real Estate
(See Sched. No. 5)
    Other Liabilities (Itemize)
    NET WORTH $
TOTAL ASSETS $ TOTAL LIABILITIES & NET WORTH $
Next

Step 9 : SUPPLEMENTARY SCHEDULES

No. 1 Banking Relations. (A list of all my bank accounts, including savings and loans)

Name and Location of Bank Cash Balance Amt. of Loan Maturity of Loan How Endorsed, Guaranteed or Secured

No. 2. Accounts, Loans and Notes Receivable. (A list of the largest amount owing to me.)

Name and Address of Debtor Amount Owing Age of Debt Description of Nature of Debt Description of Security Held Date Payment Expected

No. 3. Life Insurance

Name of Person Insured Name of Beneficiary Name of Insurance Co. Type of Policy Face Amount of Policy Total Cash Surrender Value Total Loans Against Policy Amount of Yearly Premium Is Policy Assigned?

No. 4. Other Stocks and Bonds.

Face Value (Bonds) No. of Shares (Stocks) Description of Security Registered in Name of Cost Present Market Value Income Received Last Year To Whom Pledged

No. 5. Real Estate. The legal equitable title to all the real estate listed in this statement is solely in the name of the undersigned, except as follows:

Description or Street No. Dimensions or Size Improvements Consist of Mortgages or Liens Due Dates and Amounts of Payments Assessed Value Present Market Value Unpaid Taxes
Year Amount

In submitting the foregoing application and statement, the undersigned guarantees its accuracy with the intent that it be relied upon in granting a franchise and extending credit to the undersigned and warrants that he/she has not knowingly withheld any information that might affect his/her credit risk, and the undersigned expressly agrees to notify Franchisor immediately in writing of any material change in his/her financial condition whether application for further credit is made or not and in the absence of such written notice, it is expressly agreed that Franchisor in granting a franchise or credit may rely on this statement as having the same force and effect as if delivered upon the date additional credit is requested or existing credit is extended or continued.


The undersigned consents and authorizes Franchisor to conduct a background check which may include investigation of employment history, educational background, criminal history, military records, credit history and department of motor vehicle records. All information derived from the above shall be kept confidential and be used by Franchisor for internal evaluation purposes only.

The undersigned certifies that each part of the app

DateSigned


Rev. 1/2013