FRANCHISE APPLICATION FORMTHIS FORM SHOULD NOT CONSTITUTE AN OFFER OF A FRANCHISE OR

BINDING AGREEMENT ON EITHER PARTY.

CONFIDENTIAL REPORTAPPLICANTS ARE SELECTED ON THE BASIS OF GENERAL

BACKGROUND AND FINANCIAL STABILITY. ALL INFORMATION WILLBE HELD IN CONFIDENCE.

PLEASE FORWARD TO:

VERN’S PIZZA COMPANY LTD.50710 CYNTHIA ST.SASKATOON, SKS7L 6A2

pizza intelligence.

1. PERSONAL INFORMATION

APPLICANT:

NAME: ☐ MALE ☐ FEMALE

ADDRESS:

TELEPHONE: HOME: BUS: CELL:

MARITAL STATUS: ☐ MARRIED ☐ SINGLE ☐

DATE OF BIRTH: DAY MONTH YEAR

NUMBER OF DEPENDENTS:

NAME: ☐ MALE ☐ FEMALE

ADDRESS:

TELEPHONE: HOME: BUS: CELL:

MARITAL STATUS: ☐ MARRIED ☐ SINGLE ☐

DATE OF BIRTH: DAY MONTH YEAR

NUMBER OF DEPENDENTS:

VERN’S PIZZAFRANCHISE APPLICANT PROFILE

PLEASE COMPLETE AND RETURN TO:VERN’S PIZZA COMPANY LTD.

50710 CYNTHIA ST.SASKATOON, SK

S7L 6A2

2. EDUCATION BACKGROUND

3. WORK OR BUSINESS EXPERIENCE

A: COMPLETED HIGH SCHOOL: ☐ YES ☐ NO

GRADE COMPLETED: AT:

B: POST SECONDARY/UNIVERSITY: ☐ YES ☐ NO

YEARS COMPLETED: AT:

DEGREES/DIPLOMAS OBTAINED:

PLEASE RELATE ALL WORK EXPERIENCE BEGINNING WITH PRESENT POSITION.

NAME OF COMPANY: TELEPHONE:

LOCATION OF COMPANY: PROV/STATE:

NATURE OF COMPANY’S BUSINESS:

YOUR POSITION IN COMPANY:

JOB DESCRIPTION:

DURATION OF JOB: START DATE: END DATE:

SALARY/RENUMERATION: /HR /MO /YR

MANAGERIAL REFERENCES:

pizza intelligence.

4. PERSONAL/BUSINESS REFERENCES

NAME OF COMPANY: TELEPHONE:

LOCATION OF COMPANY: PROV/STATE:

NATURE OF COMPANY’S BUSINESS:

YOUR POSITION IN COMPANY:

JOB DESCRIPTION:

DURATION OF JOB: START DATE: END DATE:

SALARY/RENUMERATION: /HR /MO /YR

MANAGERIAL REFERENCES:

1. NAME: OCCUPATION:

ADDRESS: TELEPHONE:

2. NAME: OCCUPATION:

ADDRESS: TELEPHONE:

3. NAME: OCCUPATION:

ADDRESS: TELEPHONE:

pizza intelligence.

5. QUESTIONNAIRE

A. ARE YOU PERSONALLY FAMILIAR WITH THE PRODUCTS MADE BY VERN’S PIZZA? ☐ YES ☐ NO

VERN’S PIZZA FRANCHISE? ☐ NO

☐ YES, EXPLAIN:

C. IN WHAT MANNER DO YOU WISH TO OPERATE A VERN’S PIZZA FRANCHISE?

☐ FULL TIME OPERATOR ☐ PART TIME SUPERVISOR ☐ HUSBAND/WIFE ACTIVE OPERATOR ☐

D. BRIEFLY EXPLAIN WHAT HAS PROMPTED YOUR INTEREST IN A VERN’S PIZZA FRANCHISE?

E. GEOGRAPHIC PREFERENCE 1ST CHOICE

2ND CHOICE

3RD CHOICE

F. ARE YOU NOW OR HAVE EVER BEEN AFFILIATED WITH ANY OTHER PIZZA OR FAST FOOD FRANCHISE? ☐ NO

☐ YES, EXPLAIN:

G. BANKING INSTITUTION: NAME:

ADDRESS: TELEPHONE:

CONTACT PERSON: TELEPHONE:

H. DO YOU INTEND TO FINANCE YOUR VERN’S PIZZA LOCATION ☐ WITH YOUR OWN FUNDS ☐ THROUGH A

BANKING INSTITUTION ☐ OTHER, EXPLAIN:

I. HAVE YOU EVER BEEN CONVICTED OF THEFT, FRAUD OR ANY OTHER CRIMINAL ACTIVITY? ☐ NO

☐ YES, EXPLAIN:

J. HOW WOULD YOU RATE YOUR CREDIT RATING? ☐ EXCELLENT ☐ SATISFACTORY ☐ POOR

K. HAVE YOU EVER CLAIMED BANKRUPTCY? ☐ NO ☐ YES, DISCHARGED DATE

EXPLAIN:

6. PERSONAL FINANCIAL INFORMATION

ASSETS

Cash on Hand and Banks

RRSPs:

Non-RRSP

Stocks

Mutual Funds

GICs, Term Deposits, Canada Savings Bonds

Personal Assets

Prinicipal Residence

Household Furnishings

Vehicle:

Vehicle:

Campers, Boats, Etc.

Other Real Estate

Business/Farm Assets (Net of Loans and Debts)

Describe:

TOTAL ASSETS

LIABILITIES

Account Payable (Including Credit Cards)

Mortgage on House

Vehicle Loans

Other Loans

Other Liabilities:

TOTAL LIABILITIES

NET WORTH (Total Assets minus Total Liabilities)

Applicant

$

$

Co-Applicant

$

$

Total

$

$

The information contained herein is true to the best of my knowledge. It is expressly understood that this Franchise Application Form is not binding upon either The Vern’s Pizza Company Ltd. or the undersigned as this report is

franchisee). I authorize The Vern’s Pizza Company Ltd. to make any credit checks it deems necessary, and authorize any person or consumer reporting agency to complete and furnish to you any information it may have or obtain in response to your credit inquiries.

APPLICANT SIGNATURE: DATE:

CO-APPLICANT SIGNATURE: DATE: