FRANCHISE APPLICATION


 

THE BAD ASS COFFEE COMPANY™ OF HAWAII, INC.
166 West 2700 South
Salt Lake City, Utah 84115
(801) 463-1966  *  Fax (801) 463-2606  *  Toll Free 1-(888) 422-3277
www.badasscoffee.com
 


The Bad Ass Coffee Co.™ will use this report to help evaluate your qualifications for a franchise.
THIS IS CONFIDENTIAL INFORMATION AND IS NOT A CONTRACT
OFFERING BY CIRCULAR ONLY
 Franchise
 Applicant
 First Name Middle
 Last  Date of Birth  Social Security Number
 Franchise
 Spouse
 First Name Middle
 Last  Date of Birth  Social Security Number
 PRESENT
ADDRESS		 Years &Months
 Street Address  City  State  Zip  Telephone
 (          )
PREVIOUS
ADDRESS		 Years &Months
 Street Address  City  State  Zip  Telephone
 (          )
PREVIOUS
ADDRESS		 Years &Months
(If above less than 5 years
 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 or your spouse ever been 
 declined Accident, Life or Health Insurance?

NO

YES
 If yes, Please explain.
 Highest Education Level Achieved (Circle) 8  9  10  11  12  13  14  15  16  17  18  Major:
 Spouse Education (Circle) 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 unsatisfied judgments?

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   Applicant's Spouse
Employer's Name Telephone
 (          )
Street Address
City State Zip
Job Title/Description
Supervisor's Name
May we communicate with your employer No Yes
Date of Employment From: To:
Salary Per
Month		 Begin: End:
Reason For Leaving:
Employer's Name Telephone
 (          )
Street Address
City State Zip
Job Title/Description
Supervisor's Name
May we communicate with your employer No Yes
Date of Employment From: To:
Salary Per
Month		 Begin: End:
Reason For Leaving:
Employer's Name Telephone
 (          )
Street Address
City State Zip
Job Title/Description
Supervisor's Name
May we communicate with your employer No Yes
Date of Employment From: To:
Salary Per
Month		 Begin: End:
Reason For Leaving:
Employer's Name Telephone
 (          )
Street Address
City State Zip
Job Title/Description
Supervisor's Name
May we communicate with your employer No Yes
Date of Employment From: To:
Salary Per
Month		 Begin: End:
Reason For Leaving:
Employer's Name Telephone
 (          )
Street Address
City State Zip
Job Title/Description
Supervisor's Name
May we communicate with your employer No Yes
Date of Employment From: To:
Salary Per
Month		 Begin: End:
Reason For Leaving:
Employer's Name Telephone
 (          )
Street Address
City State Zip
Job Title/Description
Supervisor's Name
May we communicate with your employer No Yes
Date of Employment From: To:
Salary Per
Month		 Begin: End:
Reason For Leaving:

 

 Will other investors participate in this franchise?       NO  YES  If yes, list name and extent of participation.
 
 
 Briefly describe your plans for managing this franchise.
 
 
 
 Would you have an interest in purchasing multiple units?   NO  YES


ENTITY / PERSONAL FINANCIAL STATEMENT

ASSETS

 LIABILITIES
 CASH ON HAND IN BANK $  SECURED NOTES PAYABLE TO BANKS $
 U.S. GOVERNMENT SECURITIES    UNSECURED NOTES PAYABLE TO BANKS  
  ACCOUNTS, LOANS, AND NOTES RECEIVABLE    NOTES PAYABLE TO RELATIVES  
CASH SURRENDER VALUE OF LIFE INSURANCE    ACCOUNTS AND NOTES PAYABLE TO OTHERS  
 STOCKS    RENTS AND INTEREST DUE  
 REAL ESTATE: Home    TAXES DUE  
 REAL ESTATE: Other    LIENS ON REAL ESTATE  
 AUTOMOBILES AND NUMBER    AUTO LOAN(S)  
 OTHER ASSETS: (Itemize)    CHARGE ACCOUNTS (Itemize)  
     As Endorser or Co-Maker  
     On Leases or Contracts  
     Legal Claims  
     Provisions for Federal Income Tax  
     Other Special Debt  
 TOTAL ASSETS $  Total Expenses $
 THE ASSETS MINUS TOTAL LIABILITIES EQUAL
 NET WORTH, OR		 $

 

SOURCE OF MONTHLY INCOME

MONTHLY EXPENSES
 SALARY $  RENT OR MORTGAGE PAYMENT  
 BONUSES OR COMMISSIONS    FOOD AND UTILITIES  
 DIVIDENDS AND INTEREST    INCIDENTALS  
 REAL ESTATE INCOME     AUTO LOAN(S)   
 OTHER    MEDICAL  
     COMPANY NAME  BALANCE DUE  PAYMENT
      $ $
         
         
         
 TOTAL INCOME $  TOTAL EXPENSES $
 The Difference Between Income and Expenses $  
 Amount of Cash Available for Franchise $  Source of Funds:
Savings $               Other $               Bank Loan $

BUSINESS / PERSONAL REFERENCES
LIST 3 REFERENCES (NOT RELATIVES OR EMPLOYERS) THAT HAVE KNOWN YOU WELL FOR AT LEAST 5 YEARS.
          NAME  ADDRESS  CITY  STATE  ZIP  OCCUPATION  TELEPHONE  YEARS
 KNOWN
               
               
               
               
               
               

BANK/CREDIT REFERENCES CHECK ONE:LLC. CORPORATION SOLE PROPRIETORSHIP INDIVIDUAL
ACCOUNT ACCOUNT NUMBER NAME OF BANK 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? When would you be available to take a franchise?
Desirable Locations or Areas 1st Choice 2nd Choice 3rd Choice
I / We do hereby represent that all of the above answers are 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

_____________________________________              _____________________________________
  Franchise Applicant Signature                                Date                                 Franchise Applicant Signature                              Date

Do Not Write Below This Line
This section is to be completed by Corporate
 
 
 
 
 
Approved?
 
 
Approved?
 
 
 
 Date