PAPGetaway Larson

							                                                                                                       REPRESENTATIVE:                Jerry Larson

                                                                                                     REP. FAX NUMBER:              1-800-775-9022

                                                                                                           TRACKING NO:
      1463 Commerce Way                Idaho Falls, ID 83401
      Phone (800) 775-9021               Fax (800) 775-9022

                           PRESS-A-PRINT GET-AWAY APPLICATION
This profile must be completed in its entirety to be considered.                                                                      PLEASE PRINT

Name 1                                       Day Ph                         7.       Check System Preference.

Name 2                                       Day Ph                           Professional Program        Master Program         Master Platinum Upgrade

Address
                                                                            8.       Do you have the funds necessary to begin this business?
City                           State            Zip                                       Yes              No

Phone             Home                                                               Source of funds

                    Fax                                                                    Savings                 Investments
                                                                                          Visa/MC              Borrowed       Other
     E-mail Address
                                                                                     If no, would you be interested in a lease purchase?
1.      Current Employment Status                                                         Yes              No


                                                                            9.       Are you in a position now to secure this business with
2.      Have you ever owned a business?               Yes            No              A.     Deposit of 20%, balance to                 Yes          No
                                                                                            follow.
        Describe:
                                                                                     B.     Payment in full.                           Yes          No


                                                                             10.     List two personal references that know you well.
                                                                                     Name
3.      Why do you feel you would succeed at the PAP Programs?
                                                                                     Address

                                                                                     Phone


                                                                                     Name

                                                                                     Address
4.      What characteristics do you possess that will contribute to your
        success?                                                                     Phone

                                                                                I understand this is not a credit application and that Press-A-Print
                                                                           is not asking for detailed financial information. I also understand that this
                                                                           questionnaire is not an “Offer to Purchase” and therefore, I am under no
                                                                           obligation.
                                                                               I realize that Press-A-Print needs to get an understanding of me and I
                                                                           submit this questionnaire with that understanding.

5.      How do you plan to operate this business?                                The act of submitting this questionnaire signifies my intent and
                                                                           interest in becoming involved in the Press-A-Print opportunity.
             By Yourself         As a Family            Hiring Employees       I/we authorize Press-a-Print International or its agent to investigate
        Explain                                                            my/our credit history.
                                                                           Name 1: Social Security No.

                                                                           Name 2: Social Security No.


                                                                                     Signature                                           Date
6.      Do you have a computer?                   Yes               No
        Do you have a fax machine?                Yes               No
        Do you have a laser printer?              Yes               No               Signature                                           Date

        Do you have a scanner?                    Yes               No


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