First Name *

Last Name *

Phone Number *

Email *

Date of birth *

Address

Street Address *

City *

Country

Postal Code *

Province of Residence *

What is the highest level of education you have completed? *

Current Employment Status *

Name of the Current Employer *

Date Hired *

Give a brief summary of your last 10 years of Work/Business experience. *

What abilities do you have which you feel particularly qualify you to own and control your own franchise business? *

Marital Status *

Spouse Full Name *

What is the current occupation of your spouse? *

Do you plan to go into business with your spouse? *

Yes

What involvement would you see your spouse having in the business? *

Will you have a partner in the business? *

Yes

Will your partner be active in business operations? *

Yes

How do you propose to fund your business? *

Do you currently own real estate? *

Yes

Market value of home *

Market value of other property *

Liquid cash available *

Shares or other investment *

RRSP’s $ *

Equity in Business (if any) *

Credit Card Debt *

Outstanding home mortgage *

Any other outstanding loan *

Preferred location? *

How soon can you invest? *

Where did you hear about us? *

Have you or a spouse even filed for bankruptcy? *

Yes

Have you even been convicted of an indictable offence? *

Yes

I attest that the information provided herein is true and correct to the best of my knowledge. I understand that Boardwalk Burgers and Fries may utilize the services of a consumer reporting agency to verify the information I have provided in the Preliminary Financial Information to evaluate my qualifications as a Boardwalk Burgers and Fries applicant. I understand the investigation may include obtaining information regarding my creditworthiness, character, general reputation, personal characteristics, or mode of living and will be obtained for the purpose of evaluating my qualifications and verifying the information contained in the personal and financial section. I hereby authorize Boardwalk Burgers and Fries to obtain a consumer report or make other inquiries about the information described herein and I hereby release Boardwalk Burgers and Fries its employees, representatives and agents from any liability as a result of the reporting of such information.