Please complete this confidential application. Your application will be reviewed by our Franchising Department and you will be contacted shortly.

Tell us about yourself

Your Name
Street Address
City
Province
Postal Code
Home Telephone Number
Work Telephone Number
Your Email Address
Your Preferred Locations
1. 2. 3.
Marital Status
Number of Children	Ages:
Other Dependents
Health Status	Excellent   Good   Fair   Other
I live in a	Home   Apartment   Other
Rent or own?	Rent   Own
How to you plan to operate this franchise?	Hands-on operator  An investor only
If married, will your spouse be active in the business with you?	Yes  No
Will you have a partner or financial backer?	Partner Yes  No   Backer Yes  No
How did you learn about Joey's Only Seafood Restaurants?

Tell us about your spouse (if applicable)

Name
Occupation
Place of Employment

Education / Background

High School
College Years	1 2 3 4 5+
Degree(s)
Business and Professional Organizations

Your Employment Experience

Your Present Employer
Date Employed
Address
Telephone
Type of Business
Current Job Title
Your Annual Salary
Name of Supervisor
Supervisor's Title

Your Bank and Financial Institution References

Chequing
Name of Firm
Branch Location and Phone Number
Savings
Name of Firm
Branch Location and Phone Number
Mortgage
Name of Firm
Branch Location and Phone Number
Broker
Name of Firm
Branch Location and Phone Number

General Information

Please describe, if applicable, any criminal or civil litigation or bankruptcy you may have been involved in within the past five years. (If none, mark N/A).

Liquid Capital to invest in your own business

Investment funds available from others (that do not require pay-back in the first 2 years of operation or longer).

Would you have a co-signer on a note?

Assuming you are awarded a franchise, when would you like to open your Joey's Only Seafood Restaurant?

Your Personal Financial Statement

ASSETS
Cash In Bank
Notes Due To Me
- Secured by real estate
- Secured by other capital
- Unsecured (Collectable)
Other Amounts Owed To Me
- Professional Accounts Receivable
- Other Collectable Amounts
Stocks and Bonds
- Marketable Stocks
- Other Stocks
- Savings Bonds
- Other
Real Estate
- Residence
- Other Residential
- Commercial
- Rural
Other Assets
- Cash Surrender Value of Life Insurance
- Automobiles
Other Assets (please specify)
Total Assets
INCOME
Annual Source of Income
- Salaries/Wages/Fees
- Bonuses/Commissions
- Dividends and Interest
- Real Estate
- Business, Professional, or Royalties
Other Income(please specify)
Total Income
LIABILITIES
Notes Due to Bank
1. To:
2. To:
3. To:
Other Notes and Payables
1. To:
2. To:
Other Notes Payables - Unsecured
1. To:
2. To:
Taxes Owing
- Income Taxes
- Other Taxes
Life Insurance Policy Loans
Due on Automobiles
Owing on Real Estate
- Residence
- Other Residential
- Commercial
- Rural
Total Liabilties
NET WORTH (Total Assets - Total Liabilities)
CONTINGENT LIABILITIES
- Guarantor Obligations
- Legal Claims
- Endorser or Co-Maker Obligations
- Leases or Contracts
- Liens or Special Debts
- Provisions for Federal or Other Taxes
Other (itemized i.e. alimony, child support maintenance, etc.)
I certify the information contained in this application is true and correct to the best of my knowledge. I authorize Joey's Only Franchising Ltd. to obtain personal information towards establishing or verifying my financial standing.

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