Confidential Agency Application Form
The completion of this application places no obligation on either New Hair Lady or the
Date of Birth:
The Agency information in this application will be
used solely by New Hair Lady in assisting its process
of determining the applicant’s eligibility as
prospective Agency. Unless otherwise specified, all
information, both personal and financial, will be
Company’s Full Name:
City & Country:
Bank Name where you maintain an account:
Number of Employees:
If you are currently employed:
Dates of employment Month / year: From: To:
Type of Business:
Describe your duties and responsibilities:
Will you continue this position if Agency is granted?
Reason for Leaving:
Have you ever owned a business? Yes / No
Name of Business:
Please give details of your business (What type? Do you still own it?):
Are you a partner or owner in any other venture? If so, what is your equity position in this venture?
What three adjectives best describe your personality?
What distinguishes you from other people?
What do you peers, co- workers and family most admire about you?
Personal References: (Do not list relatives of former employers.)
Name Address Phone
Credit References: (Companies with whom you have been done business)
Name Address Phone
What kind of the maximum amount of cash that you can invest in New Hair Lady?
What is the minimum income do you expect during the first year in business?
List the sources of capital you plan to use to establish your New Hair Lady Agency:
Number of hours you intend to work in the business:
Would you employ full time employees? Yes / No
If, yes, then, how many?
Would you establish a separate showroom / outlet for New Hair Lady Agency? Yes / No
If yes, then, where do you intend to have your showroom / outlet?
How many squatter meters is your intended showroom / outlet?
Why are you interested in New Hair Lady Agency?
Have you ever been convicted of a felony crime? Yes / No
if, yes, Date:
Should you selected to be awarded New hair Lady Agency, when would you like to start and open
General area where you prefer the Agency City:
What is your marketing plan for New Hair Lady in your area?
Please attach a full marketing plan to enable us to know what will you do for New Hair Lady?
No Agency is being offered or sold by means of this document, which is only an application. No
monies are to be submitted with this application. An offer to obtain the Agency can only be made
after you have reviewed disclosure information required by the Federal Trade commission.
The undersigned hereby authorize the release of any and all information by the above-listed
references as may be pertinent to this application.
Applicant’s Full Name: