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FRANCHISE APPLICATION - SECTION 1
You may print out this page and fax it to: 801-463-2606

FRANCHISE
APPLICANT		 First Name:
 Middle:
Last:
Date of birth: (mm/dd/yy)
FRANCHISE
SPOUSE		 First Name:
 Middle:
Last:
Date of birth: (mm/dd/yy)
PRESENT
ADDRESS		 Years & Months:
 Street Address:
 City:
 State:

 Zip:
 Telephone:
PREVIOUS
ADDRESS		 Years & Months:
 Street Address:
 City:
 State:

 Zip:
 Telephone:
PREVIOUS
ADDRESS		 Years & Months:
 Street Address:
 City:
 State:

 Zip:
 Telephone:
Have you ever been in business for yourself ?
-NO      -YES
If Yes, Please explain:
Has your spouse ever been self-employed ?
-NO      -YES
If Yes, Please explain:
Have you or your spouse had any serious illnesses or accidents within the last ten (10) years ?
-NO      -YES
If Yes, Please explain:
Have you ever been in business for yourself ?
-NO      -YES
If Yes, Please explain:
Highest Education Level Achieved: -8 | -9 | -10 | -11 | -12 | -13 | -14 | -15 | -16 | -17 | -18
Major:
SPOUSE Highest Education Level Achieved: -8 | -9 | -10 | -11 | -12 | -13 | -14 | -15 | -16 | -17 | -18
Major:
Have you or your spouse ever been convicted of something other than a minor traffic violation ?
-NO      -YES
If Yes, Please explain and include date, location, charge and disposition of charge:
Are you or your spouse subject to pending litigation or unjustified judgements ?
-NO      -YES
If Yes, Please explain:
Do you have children ?
-NO      -YES
Ages:
Business Experience / Employment History
List all history beginning with present or most recent employer.
FRANCHISE APPLICANT:
Employer's Name:
 Telephone:(xxx-xxx-xxxx)
Street address:
City:
 State:
Zip:
Job title/Description :
Supervisor's Name:
 May we contact your employer ?:
-YES -NO
Date of Employment:
From: To: 		Salary Per Month:
Begin: End:
Reason for leaving:
Employer's Name:
 Telephone:(xxx-xxx-xxxx)
Street address:
City:
 State:
Zip:
Job title/Description :
Supervisor's Name:
 May we contact your employer ?:
-YES -NO
Date of Employment:
From: To: 		Salary Per Month:
Begin: End:
Reason for leaving:
Employer's Name:
 Telephone:(xxx-xxx-xxxx)
Street address:
City:
 State:
Zip:
Job title/Description :
Supervisor's Name:
 May we contact your employer ?:
-YES -NO
Date of Employment:
From: To: 		Salary Per Month:
Begin: End:
Reason for leaving:
APPLICANT'S SPOUSE
Employer's Name:
 Telephone:(xxx-xxx-xxxx)
Street address:
City:
 State:
Zip:
Job title/Description :
Supervisor's Name:
 May we contact your employer ?:
-YES -NO
Date of Employment:
From: To: 		Salary Per Month:
Begin: End:
Reason for leaving:
Employer's Name:
 Telephone:(xxx-xxx-xxxx)
Street address:
City:
 State:
Zip:
Job title/Description :
Supervisor's Name:
 May we contact your employer ?:
-YES -NO
Date of Employment:
From: To: 		Salary Per Month:
Begin: End:
Reason for leaving:
Employer's Name:
 Telephone:(xxx-xxx-xxxx)
Street address:
City:
 State:
Zip:
Job title/Description :
Supervisor's Name:
 May we contact your employer ?:
-YES -NO
Date of Employment:
From: To: 		Salary Per Month:
Begin: End:
Reason for leaving:

FRANCHISE APPLICATION - SECTION 2

Will other investors participate in this franchise
-YES -NO
If Yes, list name and extent of participant
Briefly describe your plans for managing this franchise:
Will you be interested in purchasing multiple units ?
-YES -NO

ENTITY / PERSONAL STATEMENT

ASSETS
Cash on hand in bank:
$
U.S. Government Securities:
$
Accounts, Loans and Notes receivable:
$
Cash Surrenderr Value of Life Insurance:
$
Stocks:
 $
Real Estate Home
 $
Real Estate Other
$
Automobiles:
 $
Other Assets (ITEMIZE)
 
$
$
$
$
$
TOTAL ASSETS :
$
LIABILITIES
Secured Notes Payable to Banks
 $
Unsecured Notes Payable to Banks
$
Notes Payable to Relatives
$
Accounts and Notes Payable to Others
$
Rents and Interest Due
$
Taxes Due
$
Liens on Real Estate
$
Auto Loan(s)
$
Charge Accounts (ITEMIZE)
 
$
$
$
$
$
As Endorser or Co-Maker
$
On Leases or Contracts
$
Legal Claims
$
Provisions for Federal Income Tax
$
Other Special Debt
$
TOTAL ASSETS MINUS TOTAL LIABILITIES EQUAL NET WORTH: $

SOURCE OF MONTHLY INCOME
Salary:
 $
Bonuses or Commissions:
$
Dividends or Interest:
$
Real Estate Income:
$
Other:
 $
Other Income (ITEMIZE)
 
$
$
$
Total Income:
$
The Difference Between Income and Expenses:
$
Amount of Cash Available for Franchise:
$
MONTHLY EXPENSES
Rent or Mortgage Payment
$
Food and Utilities:
$
Incidentals:
 $
Auto Loan(s):
 $
Medical:
 $
COMPANY NAME
BALANCE DUE
PAYMENT
$
$
$
$
$
$
$
$
TOTAL EXPENSES:
$
SOURCE OF FUNDS:
SAVINGS-$
OTHER-$
BANK LOANS- $

FRANCHISE APPLICATION - SECTION 3 - REFERENCES

NAME:
 ADDRESS CITY STATE ZIP OCCUPATION TELEPHONE YEARS KNOWN

BANK_CREDIT_REFERENCES

Check one: LLC-      CORPORATION-      SOLE PROPRIETORSHIP-      INDIVIDUAL-
ACCOUNT NAME OF BANK AND STREET ADDRESS CITY STATE ZIP
SAVINGS:
CHECKING:
CHARGE ACCOUNT:
CHARGE ACCOUNT:
Briefly state why you want a Bad Ass Coffee Co.® Franchise:
What weekly income do you need
$
Desirable areas or locations:
1st Choice:

2nd Choice:

3rd Choice:

BY SUBMITTING THIS FORM:

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 the Bad Ass Coffee Co.™ 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 made be made as a result of this application and hereby authorize the release of this information to the Bad Ass Coffee Co.™  A photographic copy of this authorization shall be as valid as the original.

A copy of this form can be emailed to you. What is your email address:

Click submit button only once - process may take a few moments

After submitting your online application you will be contacted within two (2) business days by our franchise department. If not contacted by the franchise department within two days please call Harold Hill toll free at 1-888-422-3277.
 
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