Welcome to Red Eye Joe's Express -- Donuts & Gourmet Beverages On The Move -- Destin, Florida 2004

Franchise Application Form

All applications must be reviewed before awarding a franchise. All questions must be answered to process your application. All information is Confidential.

Please choose the area of the Country you are interested in:

Why did you decide to check us out?

Applicant's Name:

Street Address:

City:
State: Zipcode:

Years at this address:

Home Phone Number:
*atleast one phone number is required
Daytime Phone Number:

Email Address:
*email address is required

Date of Birth:

Social Security Number:

Employment Information

Current Employer:

Position:

Street Address:

City: State: Zipcode:

Employer Phone Number:

Salary:

Duties:

Spouse's Name:

May you be contacted at Work? Yes No
Best time to reach you:

Financial Information

Present Annual Income:

Spouse's Income:

Interest/Dividende:

Other Income:

Total Income:

Do You own your Home? Yes No

Do You own a Business? Yes No

Have You ever filed for Personal or Business Bankruptcy? Yes No

Have You had anything Repossessed?: Yes No

How do you plan to pay for the Francise Fee?

Estimated Minimum Income Required for Current Living Expenses:

Bank:

Contact:

Phone Number:

Checking Account Number:

Savings Account Number:

ASSETS	Value

Cash in Checking:
Savings:
Real Estate:
Other Real Estate:
Stocks & Bonds:
Cash surrender/Life Insurance:
Your own Business:
Appraised Collectibles:
Money Due You:
Other Assets (describe):
LIABILITIES	Value

Notes Payable to Banks:
Notes Payable to Others:
Real Estate:
Automobile:
Life Insurance:
Taxes:
Charge Accounts:
Other Liabilities:
Total Assets:
Less Total Liabilities:
Net Worth:

Exact amount of capital you have for this franchise:

If the required amount is not available, how would the investment be obtained? (Explain)

Dependents

Names:	Relationship:	Age:

Educational Information

Principle Applicant:

College:

Degree In:

High School:

Hobbies/Interests:

Husband/Wife Team, in what position & capacity will Spouse be involved?

Spouse Information

Spouse's Name:

Spouse's Current Employer:

Position:

Employers Street Address:

City:

State:

Zipcode:

Salary:

Nature of Duties:

High School:

College:

Degree In:

May you be contacted at Work? Yes No

Best time to reach you:

Hobbies/Interests:

Employer Phone Number:

Have you ever been the principal owner of a Business? Yes No

If Yes, explain

Have you ever been a Franchise owner? Yes No

If Yes, explain

Have you or your spouse (If co-applicant) been convicted,
pending,being appealed or under indictment of any felony charges? Yes No

If Yes, explain

Local Information

Do you have a location in mind? Yes No

If Yes, City, State, & Zip:

City:

State:

Zipcode:

Reference & Credit Check Information

I authorize Red Eye Joe's Express to obtain a credit report and to contact the following references and other sources to gather information about myself. I release Red Eye Joe's, it affiliates, agents and employees from any liability arising from either receipt or use of all information obtained from these sources. Yes No

Credit/Business References

Name:

Address:

City:

State:

Phone Number:

Name:

Address:

City:

State:

Phone Number:

Name:

Address:

City:

State:

Phone Number:

Personal References

Name:

Address:

City:

State:

Phone Number:

Name:

Address:

City:

State:

Phone Number:

Name:

Address:

City:

State:

Phone Number:

Success Indicators

Do you object to working evenings, weekends and holidays? Yes No

Do you get along well with others? Yes No

Do you have a background in sales? Yes No

Are you self-motivating? Yes No

Would you be willing to follow a plan to make your business a success? Yes No

Will you be willing to share your franchise experience with other franchisees? Yes No

What would be your scheduled start date?

Would you like to start this franchise?

General Health Information

Applicant Health:	Good	Fair	Poor

Back Problems:	Yes	No

Vision Problems:	Yes	No

Spouse Health:	Good	Fair	Poor

Back Problems:	Yes	No

Vision Problems:	Yes	No

Application Statement

It is understood that the purpose of this application is for information only and is in no way binding for either party. The information I have submitted within the application is true and has been completed to the best of my knowledge.

By selecting YES, I agree to the above statement and release Red Eye Joe's Express from all liability.

Yes No

*double check all of your entries to ensure accuracy and also that all the information is correct