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  Franchise Application

In order to choose us, you first need to request information about us so that you can tell that we are the absolute best. This form will get you that information.

If you simply are curious about the process to becoming a partner, you can view NEXT STEPS online.

* Denotes required fields.

Basic Information
* First Name
* Last Name
* Address
* City, State ,
* Zip Code
Country
* Home Phone
Office Phone
Fax
* Email Address
Date of Birth (mm/dd/yy)

Personal Information
Education Level (highest)
Married? Yes No
Children? Yes No
Are you a U.S. citizen? Yes No
Have you been convicted of a felony? Yes No
Have you ever filed for bankruptcy? Yes No
Do you own or rent? Own Rent

Business Experience
Present Employment
Position
From (mm/dd/yy)
Current Income
Previous Employment (1)
Position
Previous Employment (2)
Position
Spouse's Employer
Position
Income
Have you ever owned a business? Yes No
If 'Yes', What type?

References
(1) Name
Address
City, State, Zip ,
Occupation
Phone
(2) Name
Address
City, State, Zip ,
Occupation
Phone
(3) Name
Address
City, State, Zip ,
Occupation
Phone

General Information
Why would you like to become a PJ's Coffee Franchisee?
How did you hear about us?
Would you operate the store? Yes No
If NO, how would you manage it?
* How much Liquid Capital are you able to invest?

Net Worth
* Total Assets
* Total Liabilites (subtract)
* = Total Net Worth
Do you currently have a source of financing? Yes No

Location Preferences
First Choice:
Second Choice:
Third Choice:
Do you at present have a potential site? Yes No
If 'Yes'. please describe?

Conclusion
Date:

We are seeking Franchisees who not only qualify financially, but also share our vision.

This is not a contract and thereby does NOT incur obligations on either party. The filing of this application does not obligate you to become a franchisee of PJ's Coffee nor does it obligate PJ's Coffee to offer you a franchise.

By pressing SUBMIT, I authorize New Orleans Brew, LLC to make inquiries as necessary to determine the accuracy of statements made and determine my creditworthiness. I certify the above statements contained in the attachments are true as of the stated date.