PHOLICIOUS INC CREDIT DEPARTMENT

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1 APPLICATION TO PURCHASE FRANCHISE Project/DBA: Property Location: Type of Business (please check one): S or C Corporation Partnership Proprietorship TABLE OF CONTENTS Page CORPORATION APPLICATION 2 INDIVIDUAL APPLICATION 3 PARTNER S APPLICATION 3 REFERENCES 2 (For all applicants) APPLICANT S SIGNATURE & CREDIT RELEASE FORM 4 PERSONAL FINANCIAL STATEMENT 5 & 6 Page 1

2 CORPORATION (Attach a copy of the most recent audited financial statements if applicable) A. Corp Name:_ Phone #: Bus. Type: How Long in Business: State of Incorporation: How Long at this Address: Address: City, St, Zip: Own: Rent: Mortg. Co: Landlord: Address: Phone #: B. Corporation Officers: Name: Address: City, St, Zip: Name: Address: City, St, Zip: SSN: Title: Home Phone #: SSN: Title: Home Phone #: EXPERIENCES Present Business: From to Previous Business: From to Number of Stores: List PHOLICIOUS Locations (Name of Mall, City, State): List of Other Locations (Name of Mall, City, State): REFERENCES Bank Reference Bank Reference Bank Reference Name: Address: City, St, Zip: Phone #: Credit Reference Credit Reference Credit Reference Name: Address: City, St, Zip: Phone #: Page 2

3 To the extent all of the above information is contained in another document, you may forgo completion of this document and attach similar document. INDIVIDUAL PHOLICIOUS INC A. Name: Date of Birth: Home Address: SSN:_ City, St, Zip: Drivers License #: How Long At This Address: Own: Rent: Mortg. Co.: Address: City, St, Zip: Landlord Phone #: B. Previous Address: How Long At This Address: (less than 2 yr.) Own: Rent: C. Employer: Phone #: Address:_ How Long: City, St, Zip: Contact: Yes No D. Business Name: Phone #: DBA and/or Trade Name: How Long in Business: State of Incorporation: Address: Own: Rent: City, St, Zip: PARTNERS (If partners, state if general, special, or limited) A. Name: Date of Birth: Home Address: SSN #: City, St, Zip: Drivers License #: How Long at this Address: Own: Rent: Mortg. Co.: Address: City, St, Zip: Landlord Phone #: B. Previous Address: How Long at this Address: (less than 2 yr.) Own: Rent: C. Employer:_ Phone #: Address: How Long: City, St, Zip: Contact: Yes No Page 3

4 Approximate sales volume per year: $ $ $ Financial Information Request: Financial Statements (Balance Sheet, Income Statement, Cash Flow Statement (Attach if applicable) 2 Years Tax Returns (Attach if applicable) Completed Personal Financial Statement (Attach if applicable) CREDIT RELEASE FORM - INDIVIDUAL I,, do hereby give my full consent to PHOLICIOUS INC, its parent companies, agents, sub-agents or associates to request and obtain information, on my business and myself with regard to my personal and/or business credit history, both present and past history and any information relating to same. This is to be used for the purpose of establishing my current and past credit position and financial credibility. This is for the use and review only by those owner(s) and representatives of the commercial property I am interested in leasing. Applicant Signature Witness Signature Applicant Address & SSN CREDIT RELEASE FORM - SPOUSE I,, do hereby give my full consent to PHOLICIOUS INC, its parent companies, agents, sub-agents or associates to request and obtain information, on my business and myself with regard to my personal and/or business credit history, both present and past history and any information relating to same. This is to be used for the purpose of establishing my current and past credit position and financial credibility. This is for the use and review only by those owner(s) and representatives of the commercial property I am interested in leasing. Applicant Signature Witness Signature Applicant Address & SSN Page 4

5 PERSONAL FINANCIAL STATEMENT* Date: Name Address City, St, Zip To: For the purpose of securing credit from time to time with you, I furnish the following as a true and correct statement of my financial condition on data named above and agree to notify you of any material changes affecting my financial condition. In the absence of such notice, this is to be considered a continuing statement and my ability to pay has not fallen below the condition herein set forth. ASSETS.00 LIABILITIES.00 Cash (Schedule A) $ Notes Payable Banks (Schedule A) $ Stocks and Bonds (Sch B) Notes Payable to Relatives (Sch D) Accounts and Notes Receivable Notes Payable to Others (Sch D) Due from relatives and friends Accounts Payable Due from others - good Federal & State Income Taxes Payable Doubtful Other Accrued Taxes and Interest Real Estate Owned (Sch C) Mortgage Payable (Sch C) Cash Surrender Value Life Ins (Sch E) Installment Contracts Payable Other Assets (Itemize) Loans against Life Insurance (Sch E) Other Liabilities (Itemize) Total Liabilities $ Net Worth $ Total Assets $ Total Liabilities & Net Worth $ Amount of Assets Pledged $ Amount of Liabilities Secured $ Annual Income: Salary $ Fees or Commissions $ Other $ Business or Occupation: Name of Employer: Are you a partner or officer in any other businesses or ventures? Age: Marital Status: No. of Dependents: Spouse Name: (Single/Married/Widow(er)/Divorced) Spouse SSN: Are there any unsatisfied judgements or legal actions pending against you? Have you ever gone through bankruptcy or made a general assignment? As of the date of this financial statement, I had not pledged, assigned, hypothecated or transferred the title of any of my assets, except as noted on this form or on a supporting schedule, nor has any such action been taken since that date, except as follows (give details): Contingent Liabilities: As endorser or co-maker: On receivable discounted or sold: As guarantor: On leases, mortgage or contracts: Unsettled claims: Other (Itemize): *May attach separate form if one containing appropriate information is available. Page 5

6 Schedule A PHOLICIOUS INC (Please Complete ALL Schedules and Fill in All Blanks; Insert None if Appropriate) CASH BALANCES AND BANK LOANS Statement Date Method of Borrowing Name of Bank Cash Balance Amount Owing (Unsecured, Guaranty, Collateral) Cash on Hand TOTAL AS PER STATEMENT Schedule B STOCKS AND BONDS Shares or Bonds Name of Security In Name of Present Market Value If Pledged State to Whom Schedule C % Ownership Location Type (Residential, Commercial, Vacant Lot, Vacation Home, etc.) REAL ESTATE OWNED Date Title in Name of/jointly Held? Cost Recent Appraised Acquired Value Mortgage/Amount Due Are there any other liens against any of the above property? Are there any mortgage payments, interest, or taxes in arrears? Schedule D NOTES PAYABLE Amount Creditor Due Terms Collateral Schedule E LIFE INSURANCE Face Amount Name of Company Beneficiary Type of Policy Cash Vale Loans Against Policy Are any of the above policies assigned except for loans as shown? The foregoing statement is true and correct and may continue to be considered as least favorable as shown until otherwise notified in writing by the undersigned. Signature: Date: Page 6

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