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The information you furnish in this form is not binding and in no way obligates you or Billboard Connection to purchase or sell a franchise. Its purpose is to provide our company with the pertinent information needed to evaluate you as an applicant. The company will hold the answers supplied in this application in strict confidence. The information and references provided herein will not be verified without your written and/or oral authorization.

* Denotes a Required Field

Personal Information

First Name *
Middle Name
Last Name *

Spouse/Partner Information

First Name
Middle Name
Last Name

Mailing Address

Street Address
City *
State
Zip Code
Country

Contact Information

Home Phone
Best Time to Call
Business Phone
Best Time to Call

Cell Phone
Best Time to Call
Email Address *

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Personal Confidential Information

Your Date of Birth
Spouse/Partner Date of Birth
Marital Status

Have you ever filed bankruptcy Yes No
If yes, When?
Citizenship

Do you rent or own your home? Own Rent
How long have you lived at this address?
Monthly Payment

Dependent Name
Age
Dependent Name
Age

Dependent Name
Age
Dependent Name
Age

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Business Background

Your Business Background

Present Employer
Business Address
Title
Responsibilites
Length of Employment
Annual Income
Other Source of Income
Will you be leaving this employer to open
your business? Yes No
Total Combined Annual Income

Spouse/Partner Business Background

Present Employer
Business Address
Title
Responsibilites
Length of Employment
Annual Income
Other Source of Income
Will you be leaving this employer to open
your business? Yes No

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Previous Employment

Name of Employer
Postition

Address
City
State
Country

Have you at any time owned or operated your own business? (Explain below)
- Yes No
- Sold Closed Stil Own
- Full Time Part Time

Type of Business
How Long Operated

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About You

How did you become interested in Billboard Connection
What are your primary reasons for going into your own business
What are your primary concerns with owning your own business
In which geographical area(s) would you like to open your franchise
Ideally, when would you want to open your franchise?
ASAP 3 months 6 months 12 months other
Do you plan to have a partner?
Yes No
If so, will partner be active
Yes No

Partner's Name
Partner's Phone

Are you interested in obtaining a master license? Yes No
If so, what country?

Will any family members be involved in the business? Yes No

Family Member Name
Relationship

Family Member Name
Relationship

What languages do you speak

Have you ever managed employees? Yes No
If so, how many and in what capacity

My computer experience is
Rate your spouse/partner's financial management skills

My spouse/partner's computer experience is
Rate your sales experience

Rate your financial management skills
Rate your spouse/partner's sales experience

An Billboard Connection has 3 main components: Sales, Management and Production
Which component do you feel most comfortable with?
Whice component does your spouse/partner feel most
comfortable with?
Current Affiliations (fraternal,business, professional, etc.)

Any other information you want to provide

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Financial Information

Cash on hand & in banks
Stocks, bonds and securities
Retirement funds
Real estate value (Primary residence)
Other real estate value
Business owned
Other assets
Total Assets
Net worth (assets minus liabilities)
Amount of capital to invest

Liabilities

Notes payable to banks
Notes Payable to individuals
Total credit card debt
Vehicle loans
Home mortgage
Other mortgages
Other debts
Total liabilities
Source of capital

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Billboard Connection is part of the United Franchise Group

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