Application Date:

 

 

How did you first hear about our franchise program?:

(please select one)

Other Website

Internet articles

Existing franchisee

Franchising.com/cfa.ca

News/TV article

Salesperson  (name)

 

 

PERSONAL INFORMATION

Name:

 

 

 

Citizenship

 

First                      Last (family)

 

Social Security #:

SIN

 

 

 

Check One Box:

    Citizen (of)

Date of Birth:

 

 

    Permanent Resident Alien

 

Current Home Address:

 

Check One Box:

   Own

   Rent

Number and Street

 

Lived at this address for:

State/Prov, City and Zip/Postal Code

Years /Months

 

Last Prior

Home Address:
(Applicant)

 

Check One Box:

   Own

   Rent

Number and Street

 

Lived at this address for:

State, City and Zip Code

Years /Months

 

Contact Information

Applicant

Co-Applicant

Home:

 

Work/Office:

 

Fax:

 

Mobile:

 

E-mail:

 

Skype (or other IM)

 

 

Marital Status:

 

  Single

  Married or equivalent

 

 

Spouse Name:

 

 

 

 

First  

 

Last   

 

 

Will your spouse have an active role in the business?

  Yes

  No

 

 

If Yes then describe your spouse's anticipated role:

 

 

 

 

 

 

 

 

 

 

 

Would your spouse have an ownership interest in the business?

 Yes

 No

 

 

If Yes then your spouse must apply with you to become a franchisee, and your spouse must provide the information for Co-Applicant / partner.

 

 

 

 

 

 

 

Complete this section for Co-Applicant only if Applicant and Co-Applicant are partners applying together.

Social Security #:

 

Check One

Box:

 Citizen

Date of Birth:

 

  Permanent Resident Alien

 

Number of Dependents:

 

Ages of Children:

 

 

 

Applicant

Co-Applicant

If Yes to any of the following questions, then provide complete explanation and details.

Have you ever been convicted of a crime, other than traffic violations?

      Yes

 

      No

 

      Yes

 

      No

 

 

Do you have any criminal charges pending, or are you under indictment?

      Yes

 

      No

 

      Yes

 

      No

 

 

Have you ever been in bankruptcy?

      Yes

 

      No

 

      Yes

 

      No

 

 

Do you have or ever had substance dependencies? (drugs, tobacco, alcohol)

      Yes

 

      No

 

      Yes

 

      No

 

If so, what?

Do you have physical or medical limitations?

      Yes

 

      No

 

      Yes

 

      No

 

If so, explain.

 

 

YOUR INTEREST IN BECOMING A FRANCHISEE

 

Why do you want to become a franchisee?

 

 

GEOGRAPHIC INTEREST

 

Please tell us about specific area or site you have in mind. (Please note your application will not imply development rights to a site or area you identify. Certain areas are not open for our franchises.)

 

 

EDUCATION

 

Applicant

Did you graduate from high school?

 Yes

     No

If no, what was the last year completed?

  9

  10

  11

 

College or University

Years Attended

Year Graduated

Major

Degree

 

Do you speak /read English fluently?

  Yes

   No

What other languages if any, do you speak/read fluently?

 

Co-Applicant

Did you graduate from high school?

 Yes

     No

If no, what was the last year completed?

  ≤9

 10

    11

 

College or University

Years Attended

Year Graduated

Major

Degree

 

Do you speak /read English fluently?

 Yes

   No

What other languages if any, do you speak/read fluently?

 

BUSINESS EXPERIENCE

 

 

Applicant

Co-Applicant

If Yes to any of the following questions, then provide complete details, including name, state, and nature of your involvement.

Do you now or have you ever owned, managed or held an interest in any business?

        Yes

        Yes

 

        No

        No

Do you currently have an interest in any other business?

        Yes

        Yes

 

        No

        No

Have you ever been a franchisee with respect to a business not identified above?

        Yes

        Yes

 

        No

        No

 

Applicant

Current Employer
(Name, Address)

Position Details
(Title, Responsibilities, etc.)

Yearly Income

(excluding bonus and commissions)

Name and phone number of the person to whom you report

Dates Employed (From - To)

 

Previous Employer
(Name, Address)

Position Details
(Title, Responsibilities, etc.)

Yearly Income

(excluding bonus and commissions)

Name and phone number of the person to whom you report

Dates Employed (From - To)

Previous Employer
(Name, Address)

Position Details
(Title, Responsibilities, etc.)

Yearly Income

(excluding bonus and commissions)

Name and phone number of the person to whom you report

Dates Employed (From - To)

 

Co-Applicant

Current Employer
(Name, Address)

Position Details
(Title, Responsibilities, etc.)

Yearly Income

(excluding bonus and commissions)

Name and phone number of the person to whom you report

Dates Employed (From - To)

Previous Employer
(Name, Address)

Position Details
(Title, Responsibilities, etc.)

Yearly Income

(excluding bonus and commissions)

Name and phone number of the person to whom you report

Dates Employed (From - To)

Previous Employer
(Name, Address)

Position Details
(Title, Responsibilities, etc.)

Yearly Income

(excluding bonus and commissions)

Name and phone number of the person to whom you report

Dates Employed (From - To)

 

 

OWNERSHIP OF FRANCHISE AND MANAGEMENT

 

Would any person or entity, other than you have an interest in the franchise?

  Yes

If Yes, list each other person and entity who would have an interest in the business:

(up to 5, 1 must be an adult)

 

  No

Who will be the operating partner(s)?

 

A minimum of 14 hours/ week must be spent by the operating partner(s) and managers who have completed the Operations training with us.

Do you consider yourself able to undertake the physical tasks necessary to operate a greenhouse on a daily basis?

  Yes

Describe how you will be involved in the day-to-day operation:

 

   No

 

INVESTMENT FINANCING

 

A. What is your total anticipated Investment to open for business?

 

 

$  

 

 

B. What portion of the Investment would you pay in cash?

 

 

$  

List the sources of capital that you plan to use to cover the portion of the Investment above that you plan to pay in cash (e.g. savings account, stocks, etc.)

 

Sources

Amount

 

 

 

 

 

 

C. What portion of the Investment would your partner(s) pay in cash?

 

$  

D. Are you interested in a 'rent-to-own' option? Interest rates diminish with the % down.

 

 Yes

   No

E. What amount or portion of the Investment are you and your partner(s) financing?

 

$  

 

List the sources of capital that you plan to use to cover the portion of the Investment above that you plan to pay in cash (e.g. from savings account, stocks, etc.)

 

Sources

Amount

 

 

 

 

 

 

Total (B thru D above)

$  

 

IMPORTANT NOTE: The approval of your application will not imply that EdibleOrganix

has assessed whether you have reasonably estimated your total anticipated Investment.

 

PERSONAL FINANCIAL STATEMENT

As of Application Date

ASSETS

 

Applicant

Co-Applicant

Cash in banks including savings, checking, etc. (Schedule 1)

$  

$  

Marketable securities, stocks, bonds (Schedule 1)

    

    

Retirement accounts/ pensions etc (Schedule 1)

    

    

Real estate - primary residence (Schedule 2)

    

    

Real estate other (Schedule 2)

    

    

Interests held in other businesses

    

    

Other Assets (Itemize)

 

    

    

 

    

    

 

    

    

 

    

    

Subtotal

$  

$  

 

TOTAL ASSETS (add subtotals from both columns)

$  

 

 

LIABILITIES

 

Applicant

Co-Applicant

Mortgage Notes secured by primary residence (Schedule 2)

$  

$  

Mortgage Notes secured by other real estate (Schedule 2)

    

    

Loans Payable (not secured by real estate) (Schedule 3)

    

    

Credit card debt, and other revolving debt

    

    

Real estate other (Schedule 2)

    

    

Other Debts, Liabilities, and Financial Obligations (Itemize)

 

    

    

 

    

    

 

    

    

 

    

    

$  

$ 

 

TOTAL LIABILITIES (add subtotals from both columns)

$ 

 

 

 

NET WORTH (equals Total Assets Minus Total Liabilities)

$  

 

PRESENT ANNUAL INCOME

 

 

Applicant

Co-Applicant

Income

$

$

Bonus and Commissions

  

  

Dividends

  

  

Real Estate (e.g. rental income, etc.)

  

  

Other Income
(Itemize)

 

  

  

 

  

  

 

  

  

 

  

  

Subtotal

$

$

 

 

SCHEDULES TO PERSONAL FINANCIAL STATEMENT (Attach additional sheets if necessary)

Schedule 1 Asset Accounts and Individually Held Securities

Financial Institution & Account No. (or Number and Name of Securities)

Type of Account, Fund or Security

Balance or Market Value

Outstanding Loans (e.g. Margin balance)

Owner of Record

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Schedule 2 Real Estate

Property Address & Description

(e.g. single family home, etc.)

Assessed

Market Value

Mortgage & Liens

Total Annual Payments of Mortgage and Liens

$ Equity Owned by Applicant(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Schedule 3 Loans Payable (not secured by real estate)

Lender

Loan Type

Balance

Monthly Payment

Maturity/Pay Off

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Factors

Cell Phone

People vs Biz #s

Hrs/week

Apps Used (#)

Internet use (time)

 

 

 

 

 

 

Computer (model & OS)

Programs used

Hrs/week

Since

Internet use (time)

 

 

 

 

 

 

Do you or your partner have a valid driver's license?

 

 

 

 Yes

   No

Do you have the skills/desire to be involved in its building?

 

 

 

 Yes

   No

How soon do you want to start?

ASAP

90 days

180 days

Longer

 

 

Save (& complete later)

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