Franchise Application

New Jersey Coffees & Smoothies

FRANCHISE APPLICANT	First				M.I.	Last			Date of Birth
FRANCHISE SPOUSE	First				M.I.	Last			Date of Birth
PRESENT ADDRESS	Years	Street Address				City		State	Zip
	Telephone ( )		Alt. Telephone ( )			Best Time to Call	Email
Have you ever been in business for your self?				__ Yes __ No		If Yes, Please Explain:
Has your spouse ever been self-employed?				__ Yes __ No		If Yes, Please Explain:
Do you have children?				__ Yes __ No		Names/Ages:
Interests/Organizations:
How did you hear about us?

BUSINESS EXPERIENCE / EMPLOYMENT HISTORY

Franchise Applicant

Applicant’s Spouse

Employer’s Name

Telephone

( )

Employer’s Name

Telephone

( )

Street Address

City

State

Zip

City

State

Zip

Job Title

Duties

Supervisor’s Name

May we contact?

__ Yes __ No

Supervisor’s Name

May we contact?

__ Yes __ No

Date of Employment

From:

To:

Salary

Date of Employment

From:

To:

Salary

Reason for Leaving

Highest Level of Education (circle)

H.S Bachelors Master PhD

Degree:

Highest Level of Education (circle)

H.S Bachelors Master PhD

Degree:

Will other investors participate in this franchise?

__ Yes __ No

If Yes, list name and extent of participation:

How would you be involved in the business?

__ Full-Time __ Part-Time

Are you interested in multiple units?

__ Yes __ No

What income do you expect from your business?

First Year:

Second Year:

How long have you been looking for a business/franchise?

Why are you looking into a franchise now?

What is your timeframe for finding the right business?

__ Now __ 3 Months __ 6 Months __ 1 Year or Longer

Preferred Areas

Are you looking to relocate?

__ Yes __ No

If Yes, where and when?

Rate your interest in Maui Wowi on a scale of one (1) to ten (10)

Least Interested

1 2 3 4 5 6 7 8 9 10 Highly Interested

Rate your marketing skills on a scale of 1 to 10

Poor

1 2 3 4 5 6 7 8 9 10 Excellent

Rate your management skills on a scale of 1 to 10

Poor

1 2 3 4 5 6 7 8 9 10 Excellent

Rate the importance of status in the selection of a business

on a scale of 1 to 10

Not Important 1 2 3 4 5 6 7 8 9 10 Very Important

What aspects of business ownership do you find attractive?

What skills/experience do you feel will help you excel as a business owner?

What are your strengths and weaknesses related to managing a business?

What are the most important things to you when considering a business?

FINANCIAL INFORMATION

ASSETS		LIABILITIES
Cash in checking account	$	Notes Payable				$
Cash in savings account	$	Home Mortgage				$
Stocks/Bonds/Securities	$	Other Real Estate				$
Retirement Plan/IRA/401k	$	Auto Loan				$
Home (market value)	$	Credit Cards				$
Other Real Estate	$	Charge Accounts				$
Autos (market value)	$	Taxes Payable				$
Life Insurance (cash value)	$	Other Liabilities				$
Your own business	$					$
Money due to you	$					$
Other Assets (itemize)	$					$
TOTAL ASSETS	$	TOTAL LIABILITIES				$
Total Assets minus Total Liabilities Equal Net Worth		$
Source of Monthly Income		Monthly Expenses
Salary	$	Rent or Mortgage				$
Bonuses or Commission	$	Food and Utilities				$
Dividends and Interest	$	Incidentals				$
Real Estate Income	$	Auto Loan(s)				$
Other (itemize)	$	Medical
	$	CHARGE ACCOUNTS	Company Name		Balance	Payment
	$				$	$
	$				$	$
	$				$	$
TOTAL INCOME	$	TOTAL EXPENSES				$
DIFFERENCE BETWEEN INCOME AND EXPENSES	$
AMOUNT OF CASH AVAILABLE FOR FRANCHISE (Liquid Capital)	$	Source of funds:		Savings: $	Bank Loan $	Other: $

LEGAL INFORMATION

Have you or your spouse ever been convicted of something other than a minor traffic violation?	__ Yes __ No	If Yes, Please Explain and include date, location, charge and disposition of charge:
Are you or your spouse subject to a pending litigation or unsatisfied judgments?	__ Yes __ No	If Yes, Please Explain:
Have you or your spouse ever declared bankruptcy?	__ Yes __ No	If Yes, Please Explain:
Please give us any additional information not outlined above you feel would be helpful in evaluating your financial position:

Please provide any additional information that would be helpful in evaluating your potential as a franchise operator:

DEMOGRAPHICS

The following items are optional. The information you provide will have no bearing on your ability to be granted a franchise license.

First language, if other than English Language spoken at home:

If you wish to be identified with a particular ethnic group, please check all that apply:

African American, Black

Mexican American, Chicano

Native American, Alaskan Native (tribal affiliation

enrolled

)

Native Hawaiian, Pacific Islander

Asian American (countries of family’s origin

)

Puerto Rican

Asian, including Indian Subcontinent (countries

)

White or Caucasian

Hispanic, Latino (countries

)

Other (specify)

I / We do hereby represent that all of the above answers are true and complete to the best of my/our knowledge and belief. I / We recognize that Maui Wowi Hawaiian Coffees & Smoothies® is not in any way obligated to offer a franchise to me/us because of my/our execution of this document. I / We acknowledge that any false statement on this application shall be considered sufficient cause to deny further consideration. I / We understand that an inquiry regarding my/our character, general reputation, personal characteristics, mode of living and financial background may be made as a result of this application and hereby authorize the release of this information to Maui Wowi Hawaiian Coffees & Smoothies®. A photographic copy of this authorization shall be as valid as the original.

NAME

DATE

New Jersey Coffees & Smoothies

132 Old Mill Road

Chester, NJ 07930

Fax # 877-533-9995