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Coffee Franchise Information - DOC

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					TULLY’S COFFEE
Confidential Retail Store Franchise Application
PERSONAL INFORMATION
Last Name                                             First                                               M.I.       Date

Street Address                                                                                            Apartment/Unit #

City                                                  State                                               ZIP

Home Phone                                            Work Phone                                    Cell Phone

Fax                                                   Email Address

                                                                       Place of Birth
                                                                         If no, are you authorized to work in the
Are you a citizen of the United States?         YES           NO                                                       YES   NO
                                                                         U.S.?
Marital Status                 Spouse’s Name                                         Spouse’s Occupation
EMPLOYMENT HISTORY
Company                                                                Phone     (          )

Address                                                                Supervisor
                                                      # of Employees
Job Title                                                                                       Salary           $
                                                      Supervised
Responsibilities

From               To              Reason for Leaving
May we contact your previous supervisor for a
                                                          YES          NO
reference?
Company                                                                Phone     (      )

Address                                                                Supervisor
                                                      # of Employees
Job Title                                                                                       Salary           $
                                                      Supervised
Responsibilities

From               To              Reason for Leaving
May we contact your previous supervisor for a
                                                          YES          NO
reference?
Company                                                                Phone     (      )

Address                                                                Supervisor
                                                      # of Employees
Job Title                                                                                       Salary           $
                                                      Supervised
Responsibilities

From               To              Reason for Leaving
May we contact your previous supervisor for a
                                                          YES          NO
reference?
EDUCATION
High School                                                           City                                         State

From                           To            Did you graduate?   YES           NO         Degree

College                                                               City                                         State

From                           To            Did you graduate?   YES           NO         Degree

Other                                                                 City                                         State

From                           To            Did you graduate?   YES           NO         Degree

REFERENCES
Please list three professional references.

Full Name                                                                             Relationship

Company                                                                               Phone (         )

Address

Full Name                                                                             Relationship

Company                                                                               Phone (         )

Address

Full Name                                                                             Relationship

Company                                                                               Phone (         )

Address
BUSINESS PLANNING
How did you learn about the Tully’s Coffee Franchise program?

Describe any training in management, sales or business:




Do you intend to devote yourself full-time to                                If NO, please provide explanation and details how you will
the day-to-day operations of a Tully’s Coffee                                oversee the business:
franchise?
                                                      YES        NO



Have you (and if applicable, partners, officers,                             If yes, please explain and provide date of judgment:
directors or shareholders) ever been adjudged
bankrupt or reorganized due to insolvency, or
been a principle officer of a company or a            YES        NO
partner in a any partnership that was adjudged
bankrupt or reorganized due to insolvency?
Will your franchise investment come from
                                                      YES        NO
your own capital
Geographical location preferences:
                                                                             What is the timeframe to open your first Tully’s?
1)
2)                                                                           0-6 Months       6-12 Months       12-18 Months        18+ Months
3)
PERSONAL FINANCIAL DATA
ASSETS                                                          LIABILITIES

Cash on hand and in Banks                $                      Bank Notes – Secured and Unsecured        $
                                                                Notes, Loans, Advances, Accounts
U.S. Government Securities               $                                                                $
                                                                Payable
Trade Accounts and Loans
                                         $                      Credit Card Debt                          $
Receivable
Notes Receivable – Secured and
                                         $                      Loan Against Life Insurance               $
Unsecured
Life Insurance – Cash                                           Property Tax and Assessments
                                         $                                                                $
Surrendered Value                                               Payable
Stocks and Bonds – Marketable
                                         $                      Mortgage Payable on Real Estate           $
and not Real Estate
                                                                Federal and State Taxes on Current
Automobiles – Market Value               $                                                                $
                                                                Income
Other Assets, Property or Investments (itemize below)           Other Debts (Itemize Below)

                                         $                                                                $

                                         $                                                                $

                                         $                                                                $

                                         $                                                                $

TOTAL ASSETS                             $                      TOTAL LIABILITIES                         $

ANNUAL SOURCE OF INCOME                                         NET WORTH

Salary                                   $                      Total Assets                              $
Bonus and Commissions                    $                      Less Total Liabilities                    $
Dividends and Interest                   $                      NET WORTH                                 $
Real Estate Income                       $

Business Profession Income               $

Other Income (Itemize Below)
                                         $
                                         $

TOTAL INCOME                             $


AUTHORIZATION FOR RELEASE OF PERSONAL INFORMATION
By signing this application I attest to the accuracy of the information contained in this confidential Tully’s Coffee application. I
authorize Tully’s Coffee or its agents to verify the data submitted, to obtain a consumer credit report and to make such additional
credit, background, criminal or character confirmation which it deems necessary or advisable.
I further authorize Tully’s Coffee or its agents to contact present or past employers, schools, financial institutions, law enforcement
agencies and any other person, firm, corporation or source. I authorize any such source to provide Tully’s Coffee or its agents all
information concerning me, and I hereby agree to release any such source and its agents and employees from all liability for providing
this information. I understand such reports may contain information concerning my education, employment, work habits, character or
skill, criminal and credit history.
Tully’s Coffee agrees to maintain in a confidential manner and restrict the use of any information contained or obtained in connection
with this application for a Tully’s Coffee franchise. I authorize Tully’s Coffee to release to prospective financing sources any
information concerning me that may be requested by them.
By signing this application, I certify that the above statements are accurate.


Signature                                               Print Name                                      Date

				
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