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1Personal Information

2Occupation and Education

3Ownership Information

4Financial

5Legal

6Agreement

PERSONAL INFORMATION
The information you provide to us is completely confidential and will be used only to help us assess your suitability to become part of the Squeeze Franchise system as a Franchise owner. The information you provide will not be issued or revealed to any Third Party.
Name*
First Last
Email*
Enter Email Confirm Email
Birthdate*
MM slash DD slash YYYY
US Citizen*
- Yes
- No
Veteran*
- Yes
- No
Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Other Phone
Spouse's Full Name
First Last
Spouse's Birthdate
MM slash DD slash YYYY
Children- How Many?
Please enter a number from 0 to 100.
How did you find out about Squeeze's franchise opportunities?*

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OCCUPATIONAL & EDUCATIONAL INFORMATION
Current/Most Recent Employer*
Position*
Annual earnings ($)*
Please enter a number from 1 to 100000000.00.
Dates employed from:*
MM slash DD slash YYYY
To:*
MM slash DD slash YYYY
Spouse’s Current/Most Recent Employer
Spouse’s position
Spouse’s annual earnings
Please enter a number from 1 to 100000000.00.
Spouse’s dates employed from:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Have you previously been in business for yourself? If so, what?*
Do you have other sources of annual income? (ie. rentals, etc.)*
Highest level of education received:*
Hobbies, volunteer work, and other interests/training:

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OWNERSHIP INFORMATION
Will running your Squeeze be your full-time job?*
- Yes
- No
Will you have any partners in your Squeeze business?*
- Yes
- No
Are you seeking an individual franchise or multiple units?*
- Individual franchise
- Multiple units
When would you be ready to invest in your franchise if you were approved?
What are the primary goals you are looking to achieve with franchise ownership?*
What skills/experience do you have that will help you be successful in this business?*
Who will be responsible for the daily operation of your franchise?*
How much capital do you have available for the business?*
Please enter a number from 0 to 100000000.00.
How do you plan to finance your franchise?*
If additional funds are needed to start the business, are they available to you? If so, please explain.*
- Yes
- No
Explanation:*
Will running your Squeeze be your sole income source?*
- Yes
- No
Where do you want to open your Squeeze franchise?*

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FINANCIAL DATA
Assets
Cash on hand and in banks*
Please enter a number greater than or equal to 0.
Marketable securities*
Please enter a number greater than or equal to 0.
Accounts/notes receivable*
Please enter a number greater than or equal to 0.
Retirement plans*
Please enter a number greater than or equal to 0.
Real estate*
Please enter a number greater than or equal to 0.
Personal property*
Please enter a number greater than or equal to 0.
Business holdings*
Please enter a number greater than or equal to 0.
Life insurance*
Please enter a number greater than or equal to 0.
Other assets*
Please enter a number greater than or equal to 0.
Total assets
Liabilities
Mortgages*
Please enter a number greater than or equal to 0.
Accounts/Note Payment*
Please enter a number greater than or equal to 0.
Loans on life insurance*
Please enter a number greater than or equal to 0.
Credit cards total balance*
Please enter a number greater than or equal to 0.
Unpaid taxes*
Please enter a number greater than or equal to 0.
Other Liabilities*
Please enter a number greater than or equal to 0.
Total Liabilities*
Net Worth
NOTES:

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LEGAL
Are you now, or have you even been, party to any lawsuit - either as a defendant or plaintiff? OR are you a defendant in any lawsuits or legal actions?*
- Yes
- No
If so, explain:*
Have you ever been convicted of a felony?*
- Yes
- No
If so, explain:*
Have you ever filed for bankruptcy?*
- Yes
- No
If so, explain:*
Date dischared:*
Month
Day
Year
Have you ever received a conviction for a DUI?*
- Yes
- No
If so, please provide the date and case information:*
Month
Day
Year
Case information*
Anything else we should know?
Please add any additional comments regarding your business experience, personal skills, and interest that you would like us to know about as it relates to Squeeze:

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It is understood that the purpose of this application is to gather information and is in no way binding upon either the applicant or the company. It is also understood that the information supplied herein is true and accurate to the best of applicant's knowledge and that the company relies on this fact in assessing applicant's qualifications and desirability.
I certify that I am in good faith considering the possible purchase of a Squeeze Franchise, and that I am completing this request and investigating a Squeeze Franchise solely for the purpose of considering the purchase of a Squeeze Franchise.
Signature*
Date*
MM slash DD slash YYYY

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