Confidential Franchise Application

Tell us about yourself

(* Required)

Your Name *

Street Address *

City * Province * Postal Code *

Home Telephone Number * Cell Phone Number

Email *

Your Preferred Locations
1 *
2
3

Marital Status Number of Children Ages

Other Dependents

Health Status Excellent Good Other

I live in a House Apartment Other Rent or Own? Rent Own

How to you plan to operate this franchise? Hands-on Operator An Investor Only

If married, will your spouse be active in the business with you? Yes No

Will you have a partner or financial backer?   Partner Yes No    Backer Yes No

How did you learn about Joey's Urban?

Tell us about your Spouse (if applicable)

Spouse Name

Spouse Occupation

Spouse Place of Employment

Education / Background

College/University College/University Years 0 1 2 3 4 5+

Degree(s)

Business and Professional Organizations

Your Employment Experience

Your Present Employer Date Employed

Address Telephone

Type of Business

Current Job Title

Your Annual Salary

Name of Supervisor

Supervisor's Title

Your Bank and Financial Institution References

Chequing

Name of Firm

Branch Location and Phone Number

Savings

Name of Firm

Branch Location and Phone Number

Mortgage

Name of Firm

Branch Location and Phone Number

Broker

Name of Firm

Branch Location and Phone Number

General Information

Please describe, if applicable, any criminal or civil litigation or bankruptcy
you may have been involved in within the past five years. (If none, mark N/A).

Liquid Capital to invest in your own business

Investment funds available from others (that do not require pay-back in the first
2 years of operation or longer).

Would you have a co-signer on a note?

Assuming you are awarded a franchise, when would you like to open your Joey's Urban?

Your Personal Financial Statement

Assets			Liabilities
Cash in Bank	*		Notes Due to Bank
Notes Due to Me			1. To:
Secured by real estate			2 To:
Secured by other capital			3 To:
Unsecured (Collectable)			Other Notes and Payables
Other Amounts Owed To Me			1. To:
Professional Accounts Receivable			2 To:
Other Collectable Amounts			Other Notes Payables - Unsecured
Stocks and Bonds			1. To:
Marketable Stocks			2 To:
Other Stocks			Taxes Owing
Savings Bonds			Income Taxes
Other			Other Taxes
Real Estate			Life Insurance Policy Loans
Residence			Due on Automobiles
Other Residential			Owing on Real Estate
Commercial			Residence
Rural			Other residential
Other Assets			Commercial
Cash Surrender Value of Life Insurance			Rural
Automobiles
Other Assets (please specify)			Total Liabilities
			Net Worth (Total Assets-Total Liabilities)
			Contingent Liabilities
Total Assets			Guarantor Obligations
			Legal Claims
Income			Endorser or Co-Maker Obligations
Annual Source of Income			Leases or Contracts
Salaries/Wages/Fees			Liens or Special Debts
Bonuses/Commissions			Provisions for Federal or Other Taxes
Dividends and Interest			Other (itemized i.e. alimony, child support maintenance, etc.)
Real Estate
Business, Professional, or Royalties
Other Income (please specify)
Total Income

I certify the information contained in this application is true and correct to the best of my knowledge. I authorize Joey's Urban to obtain personal information towards establishing or verifying my financial standing.*