Applicant’s Name
APPLICATION FOR A FRANCHISE LISENCE
PT. Deux Essential
CONFIDENTIAL
This form, when completed, is an essential part of our consideration in granting a franchise. Please
print or type and give specific answers to all questions. All answers are held in confidence. The
completion of this form places no continuing obligation on PT. Deux Essential or on the applicant.
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Mr./Mrs./Ms. Date of Birth(date/month/year) NID KTP
Address City State/Zip Code Country
Home Phone Mobile Phone Business Phone May we contact you at your business phone?
Fax E-mail
Country of Citizenship
PERSONAL INFORMATION
EDUCATION
Last year of school completed Name of college and/or post graduate school Degree
Describe any training in sales, management or retailing
BUSINESS EXPERIENCE
1. Company Position Percentage owned Years in operation
Type of Company Address
Are you still involved? Describe duties, responsibilities, and number of employees supervised
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2. Company Position Percentage owned Years in operation
Type of Company Address
Are you still involved? Describe duties, responsibilities, and number of employees supervised
3. Company Position Percentage owned Years in operation
Type of Company Address
Are you still involved? Describe duties, responsibilities, and number of employees supervised
Have you or any business entity in which you have owned an interest been involved in bankruptcy, insolvency proceedings or
compromise with creditors? If yes, please explain:
Have you ever owned or do you now own a franchised food operation? If yes, please describe
Will you devote your full time to the CALAIS franchising business? If no, indicate how you will divide your time and whom you plan on
to assign full- time management of the business.
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FINANCIAL INFORMATION
Please attach financial statement detailing the following information and sign & date. Additionally, if you are
submitting this application with a partner, you must also provide your partner’s financial information.
Annual Income General Information
Salary $ Are you a co-signer, guarantor or endorser to
anyone else’s obligation? Yes No
Spouse’s Salary $
If yes, explain
Bonus and Commissions $
Interest and Dividends $
Other Income (Itemize) List any contingent liabilities not listed above
including leases
_________________________ $
_________________________ $
TOTAL $
I hereby acknowledge that the information contained herein is complete and accurate. I authorize
PT. Deux Essential or its authorized agent(s), to make a complete credit/character check where, and
in the manner in which, it deems necessary. I understand that this is for the purpose of general
information and is in no way binding upon PT. Deux Essential or the undersigned.
Printed Name: _______________________________________
Signature: ___________________________________________
Title: _______________________________________________
Company: ___________________________________________
Date: ____ / ____ / ___
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