Franchise Application

THE INFORMATION YOU FURNISH IN THIS FORM IS NOT BINDING AND IN NO WAY OBLIGATES YOU OR Soma Massage Therapy™ 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.

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Basic financial asset information

Cash on Hand & In Banks

Stocks, Bonds & Securities

Loans owed to you (Due w/in 1 yr)

Real Estate: (present value)

Businesses Owned

Any other assets

Basic liability information

Notes payable to bank

Notes payable to individuals

Total credit card debt

Vehicle Loans

Home Mortgage

Other Mortgages

Student Loans

Any other debts

Assets minus Liabilities

Total Assets

Total Liabilities

Assets - Liabilities = Net Worth

Amount Available to Invest(Required)

Source of Capital(Required)

Starting Date

Tell us a little about your business experience

Present Employer

Title

Responsibilities

Length of Employment

Annual Salary

Will you be leaving this employment to open your business?

Any other source of income?

Total Combined Income

Have you ever owned your own business?

What type of business?

How long operated?

How did you become interested in this business?(Required)

When would you like open?(Required)

Whats your primary reason(s) for going into your own business?(Required)

What would you consider your strengths in owning your own business?

What would you consider your primary concerns in owning your own business?

In which geographical area would you like to open your business?(Required)