Application (To be completed by Applicant and each partner and shareholder in Applicant) Thank you for considering VRKADE, Inc. This form will help you prepare and present your personal and business information which is essential for our consideration in granting Licenses. Please complete it thoroughly and note that the completion of this application form places no continuing obligation on either you and or VRKADE. Page!1
Application Form The information you provide will be held in the strictest confidence and completion of this form in no way constitutes a commitment to VRKADE or that a franchisee applicant will be automatically awarded. We encourage you to share any relevant information and include anything that you find will make your candidacy stand out as a potential franchisee. Thank you again for your interest in VRKADE. About Yourself Full Name: Home Address: City State/Province and Country: Postal Code: How long at this address: Home Phone: May we contact you here? Yes No Work Phone: Cell Phone: May we contact you here? Yes No May we contact you here? Yes No What nationality(s) are you: Other Information Describe your current business activities: Current Occupations of your proposed Operations Team: Have you ever been convicted of a felony? Page!2
Have you or anyone on your ownership team ever filed for bankruptcy? Date Filed: Date Discharged: Describe any lawsuits that you have been involved in and the nature of the lawsuits. Do you have any retail / entertainment industry experience? Yes No If yes, please advise with what company, position and number of years with the company. Do any persons related to you have any connection with any other retail / entertainment business? If yes, provide relationship and name and nature of business below. Yes No Do any other persons (whether related to you or not) associated with you have any connection with any other retail / entertainment business? If yes, explain below. Yes No Are you involved, or have you been involved in a business that may restrict you from franchising with VRKADE? Yes No Financials (All information provided is strictly confidential and will be treated as such) Assets Liabilities Cash on Hand and in Banks $ Mortgages $ Marketable Securities $ Accounts Payable $ Retirement Plan $ Notes Payable $ Accounts and Notes Receivables $ Loans on Life Insurance $ Real Estate $ Credit Cards (Total Balance) $ Personal Property $ Unpaid Taxes $ Page!3
Business Holdings $ Other Liabilities $ Other: $ Total Assets $ Total Liabilities $ Minus Total Liabilities $ Net Worth $ Real Estate Owned Address 1: Date Purchased: Original Cost: Present Value: Mortgage Balance: Address 2: Date Purchased: Original Cost: Present Value: Mortgage Balance: Address 3: Date Purchased: Original Cost: Present Value: Mortgage Balance: Page!4
Income/Expenditures Salary $ Loan Co-Signature $ Investment/Interest Income $ Legal Judgment $ Real Estate Income $ Income Taxes $ Other $ Other Special Debt $ Total $ Total $ Specific Data Assuming your review of VRKADE is positive, are you prepared to make a decision about the franchise opportunity within 90 days? Describe any training in sales, marketing, management or retailing: Why do you think a VRKADE franchise will enable you to reach your personal goals? Area/Location Preference 1. 2. 3. Who will be responsible for daily operations? Amount of cash available for investment: Source of cash for investment: Page!5
Do you have access to financing? If yes, explain below. Yes No Have you been approved for business financing? If so, what amount have you been approved for? Would this business be your sole source of income? What questions do you have about this opportunity? Applicant s Partner or Spouse s Date of Birth: Social Security No: Social Insurance No. Drivers License No.: Current Address Page!6
Authorization for Investigation I/we represent and warrant that all of the statements made by me/us in the above application are true and correct. I/we understand that if I/we make a false statement, such action will terminate my/our application for consideration. I/we understand that by signing this application, I/we authorized VRKADE to check my/our credit with a credit bureau, conduct a background and criminal investigation and conduct whatever investigation as needed. I/we agree that this application shall be and remain the property of VRKADE whether or not this application is approved. By my signature below, I herby authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, province, and country courts and agencies, military services and persons to release all information they may have about me including criminal and driving history. This authorization shall be valid in original or copy form. I/we understand that this application does not obligate either party to engage in a business transaction in any manner. Applicants Signature: Date: Partner of Spouse s Signature: Date Page!7