Franchise Application

Thank you for your interest in The Lice Place franchise system. The following will outline the process and steps that are required to be considered for The Lice Place franchise:

Complete this Franchise Application.
A separate Franchise Application should be completed by each applicant.
Upon receipt, we will review and evaluate your application and, if approved, provide you a Franchise Disclosure Document (FDD).
We may provide you with a FDD in hard copy or electronic format. If the FDD is furnished electronically, it will be provided in a Portable Document Format (PDF) file. You must use the Adobe Acrobat program in order to open and view this type of electronic file.
Upon receipt of the FDD, please complete and sign the final two pages of the document entitled “Receipt.” Once completed and signed, return the Receipt entitled “Our Copy” to us by mail to The Lice Place, 3803 S. Caulder Way, Missouri City, Texas 77459, Attention: Penny Warner.
It is recommended that you review the The Lice Place FDD with your attorney and business advisors.

Under no circumstances does the submittal of your application to The Lice Place or its subsequent review and processing imply, in any manner, our intention to offer you a franchise. You are not accepted as a franchisee unless and until you and The Lice Place execute a Franchise Agreement.

The Lice Place does not guarantee the financial performance of any franchisee or business. The decision to become a franchisee and to open The Lice Place franchise must be based upon your independent research and analysis.

PERSONAL INFORMATION

Name: *

Date of Birth: *

Social Security Number: *

Drivers License Number: *

Drivers License State:*

Spouse's Name:

Date of Birth:

Social Security Number:

Drivers License Number:

Drivers License State:

Home Phone Number:

Cell Phone Number:

Work Phone Number:

Fax Number:

Email Address:

Children Including Ages:

Highest Education Completed:*

High School College Master's Other

Home Address:*

Own Rent

City: *

State: *

ZIP Code: *

Monthly Rent or Mortgage Payment:

How Long at This Address:

If Less Than 2 Years Provide Previous Address:

EMPLOYMENT INFORMATION (Most Recent Position First)

Employer: *

Employer Address: *

Type of Business: *

Position: *

Supervisor: *

Current or Final Salary: *

Reason for Leaving: *

May We Contact Employer: *

Yes No

Employer: *

Employer Address: *

Type of Business: *

Position: *

Supervisor: *

Final Salary: *

Reason for Leaving: *

May We Contact Employer: *

Yes No

Employer: *

Employer Address: *

Type of Business: *

Position: *

Supervisor: *

Final Salary: *

Reason for Leaving: *

May We Contact Employer: *

Yes No

CREDIT REFERENCES (companies with whom you have done business)

Name: *

Contact Person: *

Address: *

Phone Number: *

Account Type: *

Name: *

Contact Person: *

Address: *

Phone Number: *

Account Type: *

Name: *

Contact Person: *

Address: *

Phone Number: *

Account Type: *

PERSONAL REFERENCES

Name: *

Phone Number: *

Address: *

Relation To You: *

Name: *

Phone Number: *

Address: *

Relation To You: *

Name: *

Phone Number: *

Address: *

Relation To You: *

GENERAL INFORMATION

How did you learn of The Lice Place franchise opportunity?

What made you approach The Lice Place about becoming a franchisee?

Are you interested in opening a single unit or multiple units?

In what city and state are you interested in operating The Lice Place franchise?

How much cash are you prepared to invest in The Lice Place franchise?

What experience do you have that would help you operate The Lice Place franchise?

What training do you believe you need to be a successful franchisee?

Will you devote your full time and attention to operating The Lice Place franchise?

If you answered no who will be responsible for operating your business?

What is your time frame for the opening of The Lice Place franchise?

Do you have a particular site or territory you are presently interested in?

If so please provide details:

Have you ever been involved with a franchised business?

If so please provide details:

FINANCIAL INFORMATION

As of this Date:

MONTHLY INCOME

Salary Wages:

Bonus Commissions:

Dividends Interest:

Real Estate Income:

Notes/Accounts Receivable:

Other Income (specify source):

Total Monthly Income:

ASSETS

Amount

Cash

Stocks and Bonds

IRA’s

401 K’s

Life Insurance (Cash Surrender Value)

Real Estate (Home)

Real Estate (Other)

Vehicles

Accounts/Loans Receivable

Other Assets:

TOTAL ASSETS

LIABILITIES

Amount

Note Payable to Banks

Notes Payable to Others

Loans Against Life Insurance

Credit Cards

Mortgage (Home)

Mortgage (Other)

Due on Vehicles

Accounts Payable

Taxes Payable

Other Liabilities:

TOTAL LIABILITIES

NET WORTH (Assets less Liabilities)

ACKNOWLEDGMENTS AND SIGNATURE

I hereby certify that the above information contained in this Franchise Application is true and correct. I understand that the above information will be utilized by The Lice Place in its evaluation of my expression of interest in acquiring The Lice Place franchise. I understand that in submitting this application I am not agreeing to be obligated to acquire The Lice Place franchise and that acceptance of my application is not an agreement to grant me a franchise opportunity, which will only occur upon execution of a Franchise Agreement. I further understand that if The Lice Place decides to proceed with my application, I will be provided, prior to execution of any binding agreement, with a Franchise Disclosure Document.

In accordance with the Privacy Act (5 U.S.C. 552 a), Freedom of Information Act, and the Fair Credit Reporting Act, I expressly authorize any past or present employer, any law enforcement agency (federal, state, or local), or any person who has personal knowledge of my character, work experience, or criminal records to release information to The Lice Place. I understand and acknowledge that as a condition of being considered for The Lice Place franchise, I agree to a credit history check and a criminal background check to be performed by a reputable agency at the choice of The Lice Place. I understand that the credit and criminal reporting agencies will make their results known to The Lice Place, and The Lice Place may use those results, in whole or in part, in determining whether I will be granted the right to enter into a Franchise Agreement with The Lice Place. If requested by The Lice Place, I agree to supply statements from my professional advisors (banker, broker, accountant, or attorney) verifying the assets stated on the application, and I also agree, if requested, to furnish copies of Federal Income Tax Returns (along with any supporting Schedules) as filed for the last three years. I understand that The Lice Place is relying upon all of the information contained in this application as a material factor in considering my application to become a franchisee, and I therefore agree to promptly notify The Lice Place of any material change in any of this information or any subsequent information provided to The Lice Place. In addition, I release from liability and hold harmless all persons releasing personal, professional, or financial information on me or any company to which I am a partner or shareholder listed on this application.

I further agree to provide a detailed resume and a current personal financial statement upon the request of The Lice Place.

I Agree *

Date