FRANCHISE FORM

First Name: Last Name:

Citizen of: Date of Birth: Select One 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2001 2002 2003 2004 2005 2006 2007 2008 2009

Gender: Select One Male Female

Address:

City: Province: Select One Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory

Country: Zip/Postal Code:

Phone: Fax:

Mobile: Email:


How did you hear about us?



Have you ever been convicted of a felony?

Select One Yes No

Have you been involved in any litigation proceeding within the last 5 years?
(If yes, additional information will be required at the time of sale.)

Select One Yes No


Have you ever filed for bankruptcy?

Select One Yes No

What is your food service experience level?



If qualified when will you be ready to invest in a franchise ?

Select One Immediately Within 6 Months 6 Months to a Year Over 1 Year

Preferred Location(s) or Area(s):

Educational Background

Highest Education Level



Schools Attended

Partners

Will you have partners?

Select One Yes No

Partner One

First Name Last Name

% of Ownership Type of partner? Select One Active in Store Involvement Silent Partner


Partner Two

First Name Last Name

% of Ownership Type of partner? Select One Active in Store Involvement Silent Partner


Partner Three

First Name Last Name

% of Ownership Type of partner? Select One Active in Store Involvement Silent Partner

Be sure to fill in all the fields so that we can respond to your request.

I authorize Lee Garden to obtain or exchange any personal information with any personal information agent towards establishing or verifying my financial position. I certify the statements contained are true.