Franchise

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

REFERENCES

Phone

Name

Account Number

Address

Phone

Name

Account Number

Address

Phone

Name

Account Number

Address

Phone

BANK REFERENCES

Name

Account Number

Address

Phone

Checking
Savings
Loan

Name

Account Number

Address

Phone

Checking
Savings
Loan

PERSONAL FINANCIAL STATEMENT

Checking Account

Savings Accounts, Certificates

U.S. Government Securities

Listed Securities

Unlisted Securities

Accounts and Notes Receivable

Real Estate Owned (home)

Real Estate (other)

Real Estate Mortgaged Receivables

Automobile

Other Personal Property

Life Insurance

How much available cash are you willing to put into the franchise?

Is any part of the purchase price being obtained from a source other than shown above?

Yes
No

If yes, please explain:

MISCELLANEOUS

Have you ever owned or do you currently own a business?

Yes
No

If yes, please explain:

I/We represent and warrant that all of the statements made by me/us in this application are true and correct. I/We understand that if I/we make a false statement, such action will terminate my/our applilcation for consideration. I/We understand that by signing this statement, Country Style Ice Cream at some point through the interview process, will check my/our credit with a credit bureau. I/We agree that this application shall be and will remain your property whether or not this application is approved. This application does not obligate either party in any manner.

Tastes Like Homemade

If you would like to own and operate a Country Style Ice Cream franchise, simply print out the franchise form, fill it out and mail it to Country Style.

CONFIDENTIAL FRANCHISE QUALIFICATION QUESTIONNAIRE

REFERENCES

BANK REFERENCES

PERSONAL FINANCIAL STATEMENT

MISCELLANEOUS