FRANCHISE REQUEST

Print this form, fill in the blanks and fax it to us (Atn. Mr. Henrri Marjani) or e-mail it to our plant in La Victoria.


   PERSONAL INFORMATION.

Name and Surname:

I.D. Number:

Address:

City:

State:

Country:

Home Telephone(s):

Work Telephone(s):

Cell Phone:

Nationality:

Date of Birth:

Status:

Wife/Husband Name:

I.D. Number of Wife/Husband:

Number of persons depending on you:

Own house:

Rented House:

Time of residence in the place:

State name and address of 03 relatives that don't live with you:

1) Name:
Address:
Telephone:
Kinship:

2) Name:
Address:
Telephone:
Kinship:

3) Name:
Address:
Telephone:
Kinship:

EDUCATION

Academic Courses

State any extra course/studies





PROFESSIONAL EXPERIENCE.

Occupation:
Title:
Name of Enterprise:
Address:

Describe briefly your occupation and activities:




PREVIOUS JOBS

Enterprise:
Starting Date:
Retirement Date:
Cause of Retirement:

Enterprise:
Starting Date:
Retirement Date:
Cause of Retirement:

Enterprise:
Starting Date:
Retirement Date:
Cause of Retirement:

Have you managed a bussiness/store before? Yes    No
If answered Yes, please state nature of bussiness




Is this store/bussiness currently active? Yes No
If Not, state reasons, please.




PERSONAL FINANCIAL SITUATION

Can you face the financial charges of a franchise? On which resources? Please state.



CONTRIBUTION AND SITE

Do you have access to a site? Yes    No
If yes, state if you own it or rent it.

If not, Do you plan to? Yes No
State site location


Area of site:

Length of Storefront



How did you learned of Axum?



Why would you like to own a Kitchen & Bath store?



What do you expect from an Axum franchise?



MISCELLANEOUS INFORMATION

Do you have any kind of legal problems at the time? Please state.