Print Form
#0 Town Plaza PMB 222 Durango, Colorado 830 toll free. 877-247-2770 ph. 970-247-2770 fax. 970-247-2735 www.fuzziwigscandyfactory.com
Franchise Application (mail or fax completed application to the above address)
Personal Data
Name Name Address City Phone Email Franchise will be: Fax ST Zip Date of Birth Date of Birth SS# SS#
❏ An individual
❏ A partnership
❏ A corporation
If you plan to have business partners, list names and addresses below. If names are to be included on the Franchise Agreement, please have these individuals fill out a separate application.
Name Name
Address Address
City/St/Zip City/St/Zip
Phone Phone
Educational Background
Name High School College College Graduate City/ST Yrs Attended Degree Major
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Employment History (please include resume if available)
From-To Company Position Annual Income
Income
Current salary Bonus & commissions Do you have a financing source? Dividends & interest Other investment income Total annual income Will Fuzziwig’s Candy Factory be your sole source of income? Do you have at least $75,000 to invest in a Fuzziwig’s Candy Factory Franchise?
❏ no
❏ yes ❏ no ❏ yes
If yes, please list your source and the amount of financing available.
❏ no
❏ yes
Please explain:
Personal References
Name . 2. 3. 4. Address Phone
Credit References
Name . 2. 3. 4. page 2 of 4 Address Phone
Business Development Information
Have you seen an existing Fuzziwig’s Candy Factory?
❏ no ❏ yes
What market area(s) are you interested in for your Fuzziwig’s Candy Factory?
When would you be available to open your Fuzziwig’s Candy Factory? Who will be responsible for the daily operations of the business? Please briefly describe why you want to have your own business and why you believe Fuzziwig’s Candy Factory may be right for you.
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Personal Financial Statement
Assets Cash on hand and in banks Notes & accounts receivables Cash surrender value life insurance Stocks & bonds Real estate Automobiles Personal property Other assets Total Assets $ $ $ $ $ $ $ $ $ LIAbILItIes Notes payable to banks Notes and accounts due others Loans against life insurance Due to brokers Unpaid real estate taxes Unpaid income taxes Mortgages payable on real estate Other debts Total Liabilities $ $ $ $ $ $ $ $ $
sOURCes OF INCOMe (Alimony, child support or maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.) Salary Bonus and/or commissions Dividends and/or bond interest Real estate income (net) Other income (itemize) $ $ $ $ $ $ $ Total Income $
CONtINgeNt LIAbILItIes As endorser, comaker or guarantor On leases or contracts Letter of credit Total Contingent Liabilities $ $ $ $
bANks & FINANCe COMpANIes wheRe CRedIt hAs beeN ObtAINed Name & Address High Credit Loan Type
I warrant that there is no judgment against me nor lien unsatisfied upon my property, except as shown, nor prior suit pending against me in any court, that no assets are pledged in any manner not shown herein. The foregoing financial statement has been fairly and correctly presented according to the best of my knowledge and belief. The undersigned understand that Fuzziwig’s Candy Factory, Inc. may wish to verify or investigate the undersigned parties credits and expressly authorize any verification or investigation that Fuzziwig’s Candy Factory, Inc. deems necessary. All information will be kept confidential.
Signature Signature
Date Signed Date Signed
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