Personal Information

Name Date Of Birth Address Marital Status Single Married Divorced Separated City Spouse or Partner's Name Province Phone Number Postal Code Cellular Number Your Email Address

Business Experince

Currently Employed by Date Started Position Held in Firm Monthly Income Previously Employed by For How Long

Personal Financial Information

Will you require financing?      Yes No How much capital, if any will you have to borrow?      $0-$50,000 $50,000-$75,000 $75,000-$100,000 over $100,000 How much cash do you have to invest right now?   $0-$15,000 $15,000-$25,000 $25,000-$50,000 $50,000-$100,000 over $100,000 Have you ever declared bankruptcy?   Yes No What is the market value of real estate you own?   less than $100,000 $100,000-$150,000 $150,000-$250,000 $250,000-$500,000 over $500,000 What is the market value of automobiles you own?   less than $20,000 $20,000-$50,000 over $50,000 How much credit card debt do you have right now?   less than $5,000 $5,000-$10,000 $10,000-$20,000 more than $20,000 Approximate net worth (assets / liabilities)   less than $250,000 $250,000-$500,000 $500,000-$750,000 $750,000-$1M over $1M What amount of profit would you need to make within the first two years of running a Postcard Portables franchise?   Break Even $0-$20,000 $20,000-$50,000 $50,000-$100,000 What is your 5-year cumulative profit goal?

General Information

When will you be available to open up the business?   Immediately Within 1 month Within 3 months Later this year If you were awarded a Postcard Portables franchise how many hours per week would you devote to running your business?   0-20 20-30 30-40 40-50 over 50 How much hours each day would you spend on prospecting?   1 2 3 4 5 6 7 8 Will your partner/spouse be active in the business?   Yes No Have you ever rented a portable sign before?   Yes No What do you like most about our concept and products?   Why do you feel you could be successful in this business?   Have you ever been self-employed before?   Yes No Have you ever owned a franchise before?   Yes No

I hereby certify that all information provided is correct and true as of the date provided. I understand that any false information or omission of pertinent information in this application would be cause for immediate termination of any subsequent agreement reached between myself and Postcard Portables Canada.