Saint Cinnamon - Application Form To determine mutual compatibility and financial responsibility, we ask you to fill out this form for careful evaluation by our management. The information supplied by you will be held in the strictest confidence. The submission of this form does not constitue an agreement by either party and is purely for information purposes. Thank you very much.   Name: Last Name:   Home Address:   City:   Prov/State: Postal Code/ZIP:   Do you own a home ?:   - yes no _     Years at Present Address?:      Home Phone: Office Phone:   Email:   Date of Birth:    Marital Status:   - Single Married Divorced   # of Dependents:      Social Insurance Number      Education (Highest Level Attained): - High School College University   Spouse's Name: Occupation: References (list 3 character references):       Name: Phone: Fax: Occupation:   1   2   3   Employment during last 10 years (list present or last job first)     Employer Duties Salary Employment Date   1 fr: to:   2 fr: to:   3 fr: to:     I make the following statemnet of all my assets and liabilities as of: Assets Liabilities and Net Worth Cash $ Notes Payable to Bank (Borrowings only) $ Accounts and Loans Receivable $ Notes Payable to Others $ Life Insurance (Cash Surrender Value) $ Loans Against Life Insurance $ Stocks and Bonds $ Accounts Payable $ Real Estate $ Mortgage Payable on Real Estate $ Automobiles (registered in own name) $ Other Liabilities $ Other Assets $     Total Assets $ Total Liabilities $   Banking Relations (list of all bank accounts including savings and loans)   Name, Location and Tel# of Bank Cash Amount of Loan   Salary $ $ $   Bonus and Commission $ $ $   Dividends $ $ $   Real Estate Income $ $ $   Other Income $                     Total $               General Information   How did you become interested in our franchise? Geographic preference: 1st choice: 2nd choice:   3rd choice: 4th choice:   5th choice: 6th choice:   How much capital are you able to invest?   Do you currently have a source of financing? Yes No   Additional information that may be helpful:   *Note: Please provide name, address, phone and fax of personal and business bank managerl: I authorize investigation (including the preparation of credit reports) of all statements contained herein, and the financial information disclosed herein, release all parties from all liability for any damage that may result from furnishing any information to you.           TOP home | our products | regional developer | franchising | contact us | what's new | about us © 2007 All Rights Reserved.