9/14/23, 2:30 AM Lady M
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Licensing Application Form
Thank you for your interest in Lady M Confections. Please complete the application in full. You will be contacted when a business opportunity becomes available.
All fields are required unless otherwise noted.
I. Personal Background
TITLE*
- Select -
FIRST NAME* MIDDLE NAME(OPTIONAL) LAST NAME*
First Name First Name Last Name
SUFFIX(OPTIONAL)
- Select -
E-MAIL ADDRESS*
Last Name
HOW DID YOU HEAR ABOUT LADY M?*
- Select -
DATE OF BIRTH*
GENDER*
MALE
FEMALE
N/A
PHONE NUMBER*
Country Code Local Number Extension
ADDRESS LINE 1*
Address Line 1
ADDRESS LINE 2*
Address Line 2
CITY* STATE/REGION* ZIP/POSTAL CODE*
City State Zip
COUNTRY/REGION*
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Country
ARE YOU A CITIZEN OF THE COUNTRY/REGION YOU PROVIDED ABOVE?*
YES
NO
HAS A JUDGMENT/LIEN/BANKRUPTCY BEEN FILED AGAINST YOU OR HAVE YOU BEEN INVOLVED IN ANY LITIGATION PROCEEDING?*
YES
NO
HIGHEST EDUCATION ATTAINED*
- Select -
EMPLOYMENT STATUS*
- Select -
II. Business Information
BUSINESS NAME*
NATURE OF BUSINESS*
BUSINESS WEBSITE URL*
BUSINESS TITLE*
NUMBER OF YEARS EMPLOYED AT THE BUSINESS*
BUSINESS EXPERIENCE LEVEL*
- Select -
III. Financial Information
IN WHAT COUNTRY/REGION WOULD YOU LIKE TO OPEN YOUR RESTAURANT?*
Country
If a specific country or region is not listed, the license is no longer available.
HOW WOULD YOU FINANCE YOUR LADY M OPERATIONS?*
INCOME FROM CURRENT OCCUPATION*
$ - Amount in USD -
INCOME FROM OTHER SOURCES*
$ - Amount in USD -
PLEASE EXPLAIN OTHER INCOME*
TOTAL VALUE OF LIQUID ASSETS*
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$ - Amount in USD -
TOTAL VALUE OF FIXED ASSETS*
$ - Amount in USD -
TOTAL LIABILITIES*
$ - Amount in USD -
INDIVIDUAL TOTAL NET WORTH*
$ - Amount in USD -
HOW INVOLVED WILL YOU BE IN OPERATING THE BOUTIQUE?*
- Select -
Disclaimer
I understand that the granting of a license is at the sole discretion of the Licensor (Lady M Confections Co., Ltd.). For any license to be located outside of the
United States, I understand that I must provide the requisite photo identification to the Licensor to verify my identity prior to any sale or transfer and upon
request during the term of any license agreement entered into with the Licensor.
I understand that any information I receive from the Licensor or from any employee, agent or licensee of the Licensor or its affiliate is highly confidential
(“Confidential Information”), has been developed with a great deal of effort and expense to the Licensor, and is being made available to me solely because of
this application. I agree that I shall treat and maintain all Confidential Information as confidential, and I shall not, at any time, without the express written
I HAVE READ THE AGREEMENT ABOVE AND I CONSENT TO ELECTRONIC DISCLOSURE*
Submit
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