Franchise Application

Franchise Application Form

PERSONAL & BUSINESS INFORMATION

Name:(Required)

Email Address:(Required)

SIN #:(Required)

Address(Required)

Street Address

City

State / Province / Region

ZIP / Postal Code

Drivers License #:(Required)

DOB:(Required)

DD slash MM slash YYYY

CDN Citizen:(Required)

Yes

Marital Status:(Required)

Single

Married

Home Phone:(Required)

Business Phone:(Required)

Spouse’s Name:(Required)

Spouse’s Occupation:(Required)

Children’s Names/Ages:(Required)

Education:(Required)

Current Business or Employer:(Required)

Address:(Required)

Position:(Required)

Date of Employment From:(Required)

DD slash MM slash YYYY

Date of Employment Till:(Required)

DD slash MM slash YYYY

What were your major responsibilities?(Required)

Why are you looking for a new business opportunity?(Required)

How long have you been looking for a business?(Required)

What is your projected date to start your business?(Required)

What geographical area have you defined for your business opportunity?(Required)

Would you be an active participant or a passive investor?(Required)

Would you be involved in this business on a part-time or full-time basis?(Required)

How many hours can you devote per week?(Required)

How many hours can you devote per month?(Required)

Do you intend to supervise this business?(Required)

Yes

If not, what role will you play?(Required)

Do you have a financial partner?(Required)

Yes

If yes, please list:(Required)

Do you plan on obtaining a loan to start your business?(Required)

Yes

If yes, what source?(Required)

Annual personal income desired (once the business is established ):(Required)

Based upon previous experience, what did you like most about your past jobs or businesses?(Required)

What did you like least about your past jobs or businesses?(Required)

How do you think operating your own business will relieve some of the business-related frustrations you experienced in the past?(Required)

Based on past experience, your strengths are:(Required)

Based on past experience, your weaknesses are:(Required)

What do you consider your highest achievement?(Required)

Rate yourself on a scale of 1 to 5 (5 is the strongest) in the following personality characteristics:

Independent(Required)

Motivated(Required)

Management(Required)

Technical(Required)

Creative(Required)

Problem-solver(Required)

Self-confident(Required)

Energetic(Required)

Decision-maker(Required)

Money-oriented(Required)

People-oriented(Required)

Communicator(Required)

Determined(Required)

Patient(Required)

Crisis Manager(Required)

Achiever(Required)

Detailed(Required)

Sales/Marketing(Required)

Intellectual(Required)

Leader(Required)

CREDIT REFERENCES – Include name, address & phone number

CREDIT REFERENCE 1(Required)

CREDIT REFERENCE 2(Required)

CREDIT REFERENCE 3(Required)

BUSINESS REFERENCES – Include name, address & phone number

BUSINESS REFERENCE 1(Required)

BUSINESS REFERENCE 2(Required)

BUSINESS REFERENCE 3(Required)

PERSONAL REFERENCES – Include name, address & phone number (no employees or relatives)

PERSONAL REFERENCE 1(Required)

PERSONAL REFERENCE 2(Required)

PERSONAL REFERENCE 3(Required)

FINANCIAL INFORMATION

(Attach prepared financial statement, if available)

Assets

Cash in Chequing Account(Required)

Cash in Savings Account(Required)

Real Estate, Home(Required)

Other Real Estate(Required)

Cash Surrender of Life Insurance(Required)

Stocks and Bonds(Required)

Your own Business(Required)

Automobile(s)(Required)

Appraised Collectables(Required)

Money due You(Required)

RRSP’s(Required)

Other Assets (Please List)(Required)

Liabilities

Notes Payable to Banks(Required)

Notes Payable to Finance Companies(Required)

Real Estate Indebtedness(Required)

Automobile(s) Indebtedness(Required)

Owing on Life Insurance(Required)

Charge Accounts and Bills Due(Required)

Taxes Payable(Required)

Other Debts or Obligations(Required)

Other Liabilities (Please List)(Required)

Total Assets(Required)

Less Total Liabilities(Required)

Net Worth(Required)

SOURCE OF INCOME

Salary(Required)

Bonuses and Commissions(Required)

Dividends(Required)

Real Estate(Required)

Other Income – Itemize(Required)

TOTAL(Required)

CONTINGENT LIABILITIES

As Endorser or Co-signer(Required)

On Lease or Contracts(Required)

Legal Claims(Required)

Provision for Federal/Provincial Income Taxes(Required)

Other Special Debts(Required)

TOTAL(Required)

What will be your source of income to cover personal living expenses during the initial start-up?(Required)

Are any assets pledged?(Required)

Are you a defendant in any suits or legal action?(Required)

Have you ever made a composition settlement?(Required)

Explain(Required)

Have you ever filed for bankruptcy?(Required)

Explain(Required)

I submit the foregoing as accurate and complete and consent to Let's Get Moving Canada Inc.
Sharing this information with third parties involved in the business of conducting reference,
background or credit checks to verify the accuracy of the information submitted. I understand that
all information provided by Let's Get Moving Canada Inc. is strictly confidential and will not be
used in whole or in part for competitive purposes.

Signature:(Required)

Date(Required)

DD slash MM slash YYYY

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Franchise Application