simpleFLOORS Franchise

Last Name:

Birth date:

Age:

First Name:

Phone no:

Middle Name:

Cell no:

Email:

Current Address:

City:

State:

Zip:

How long:

Rent or Own:

Rent Own

Will the franchise be owned and operated by yourself, family members or a group?

How soon do you want to get into business?Please explain fully.

Amount of capital available for business. Describe fully

Territory for which application made:

Would you consider any other area?

Yes No

Please list Educational background:High School, College(degree if any), Millitary

How you been in business for yourself? describe

Name and Address of Employer

Position, Title and Duties

Dates of employment

From:

To:

This is not a contract and supplying or completing this form incurs no obligation on either party.