Application

Franchise Application

Exhibit B
to Franchise Disclosure Document

LADY BUG FRANCHISE CORPORATION
CONFIDENTIAL APPLICATION

This application must be fully completed in order to be accepted for consideration.

Please print or type
Date://

GENERAL INFORMATION

PRINCIPAL APPLICANT'S NAME :
DATE OF BIRTH :
SOCIAL SECURITY NUMBER :

RESIDENCE ADDRESS :

CITY:
STATE:
ZIP:
HOME PHONE :
BEST TIME TO REACH :
HOW LONG AT PRESENT ADDRESS :
OWN? :
RENT? :

PREVIOUS ADDRESSES (List for 10 years) :

CURRENT EMPLOYER :

POSITION:
NATURE OF DUTIES :

EMPLOYER'S ADDRESS :

MAY WE CONTACT YOU AT WORK? :

BUSINESS PHONE :
BEST TIME TO REACH :

EDUCATION

HIGH SCHOOL :
COLLEGE :
DEGREE IN :

HOBBIES AND INTERESTS :
ATTACH RESUME IF AVAILABLE :
SPOUSE IF HUSBAND/WIFE TEAM, IN WHAT POSITION AND CAPACITY WILL SPOUSE BE INVOLVED? :
SPOUSE'S NAME :
SPOUSE'S DATE OF BIRTH:

SPOUSE'S SOCIAL SECURITY NUMBER :

SPOUSE'S RESIDENCE ADDRESS :

SPOUSE'S HOME PHONE :
BEST TIME TO REACH :

SPOUSE'S CURRENT EMPLOYER :

POSITION :
NATURE OF DUTIES :

EMPLOYER'S ADDRESS :

MAY WE CONTACT YOU AT WORK? :
BUSINESS PHONE :

BEST TIME TO REACH :

EDUCATION - SPOUSE

HIGH SCHOOL :
COLLEGE :
DEGREE IN :

HOBBIES AND INTERESTS :

ATTACH RESUME IF AVAILABLE:

GENERAL HEALTH

PRINCIPAL APPLICANT:

GOOD FAIR POOR 

BACK PROBLEMS?  VISION PROBLEMS? 

SPOUSE:

GOOD FAIR POOR 

BACK PROBLEMS?  VISION PROBLEMS? 

DEPENDENTS

NAMES AND AGES OF CHILDREN :

OTHER DEPENDENTS?:
RELATIONSHIPS AND AGES :

WILL YOU HAVE A PARTNER OR OTHER PARTNERS OTHER THAN YOUR SPOUSE? :

IF YES, WHAT WILL BE THEIR INVOLVEMENT? :

PLEASE HAVE THEM FILL OUT A SEPARATE APPLICATION.

BACKGROUND

HAVE YOU OR YOUR SPOUSE BEEN CONVICTED OF ANY FELONY CHARGES? DO YOU OR YOUR SPOUSE HAVE ANY FELONY CHARGES PENDING, BEING APPEALED, OR ARE YOU UNDER INDICTMENT? :

FINANCIAL INFORMATION

PRESENT ANNUAL INCOME :

SPOUSE'S PRESENT ANNUAL INCOME :

INTEREST AND DIVIDEND :

OTHER INCOME :

TOTAL INCOME:

ATTACH PREPARED FINANCIAL STATEMENT, IF AVAILABLE YOUR BANK :

BANK PHONE :
BANK OFFICER :
CHECKING ACCOUNT NO:
SAVINGS ACCOUNT NO. :
DO YOU OWN YOUR OWN HOME? :
DO YOU OWN YOUR OWN BUSINESS? :
HAVE YOU EVER FILED FOR PERSONAL OR BUSINESS BANKRUPTCY? :
HAVE YOU EVER HAD ANYTHING REPOSSESSED? :
HOW DO YOU PLAN TO PAY FOR THE INITIAL FRANCHISE FEE? :

WHAT IS YOUR CUSTOMARY EARNINGS LEVEL? :

SPOUSE'S?:

ESTIMATED MINIMUM INCOME REQUIRED FOR CURRENT LIVING EXPENSES? :

ASSETS

CASH IN CHECKING :

CASH IN SAVINGS :

REAL ESTATE (HOME) :

OTHER REAL ESTATE :

Describe :

CASH SURRENDER VALUE OF LIFE INS:

STOCKS AND BONDS :

AUTOMOBILES:

CHARGE ACCOUNT :

YOUR OWN BUSINESS :

APPRAISED COLLECTIBLES :

Describe:

MONEY DUE YOU:

OTHER ASSETS :

Describe:

LIABILITIES

NOTES PAYABLE TO BANKS :

NOTES PAYABLE TO OTHERS :

REAL ESTATE DEBT :

OTHER REAL ESTATE DEBT :

OWING ON LIFE INSURANCE :

TAXES PAYABLE :

AUTOMOBILE DEBT :

OTHER LIABILITIES :

Describe:

TOTAL ASSETS :$

LESS TOTAL LIABILITIES:$

NET WORTH:

EXACT AMOUNT OF CAPITAL YOU HAVE FOR THIS FRANCHISE :$

IF THE REQUIRED AMOUNT IS NOT AVAILABLE, HOW WOULD THE INVESTMENT BE OBTAINED? PLEASE EXPLAIN IN DETAIL:

HAVE YOU EVER BEEN A PRINCIPAL OWNER OF A BUSINESS BEFORE? :

IF YES, BRIEFLY EXPLAIN:

HAVE YOU EVER BEEN GRANTED A FRANCHISE OR LICENSE BEFORE? IF YES, BRIEFLY EXPLAIN:

LEGAL FORMAT

SOLE PROPRIETOR :

CORPORATION:

PARTNERSHIP :

OTHER :

name:

name:

name:

name:

LOCATION

DO YOU HAVE A LOCATION IN MIND ALREADY? :

IF SO, IN WHAT CITY AND, IF KNOWN, WITH ZIP CODE? :

CREDIT REFERENCES

Name:
Contact Person :
Address:
Telephone Number:

Type of Account and Account Number:

Name:
Contact Person :
Address:
Telephone Number:

Type of Account and Account Number:

BUSINESS REFERENCES

Name:
Contact Person :
Address:
Telephone Number:
Name:
Contact Person :
Address:
Telephone Number:

PERSONAL REFERENCES (do not list friends or relatives)

Name:

Address :
Telephone Number :

Name:

Address :
Telephone Number :

SUCCESS INDICATORS

DO YOU ENJOY AND GET ALONG WELL WITH PEOPLE? :

DO YOU HAVE A BACKGROUND IN SALES? :

CAN YOU FEEL COMFORTABLE IN PRESENTING A SERVICE IN WHICH YOU BELIEVE? :

ARE YOU A SELF MOTIVATOR? :

WILL YOU BE WILLING TO SHARE SOME OF YOUR BUSINESS EXPERIENCES OF YOUR FRANCHISE WITH OTHER LADY BUG FRANCHISEES?:

ARE YOU WILLING TO FOLLOW A PLAN TO MAKE YOUR BUSINESS SUCCESSFUL? :

IF WE WERE TO GO AHEAD, WHAT WOULD BE YOUR SCHEDULE FOR STARTING? :

WHY DO YOU THINK YOU WOULD ENJOY AND DO WELL IN THIS BUSINESS? :

APPLICATION DECLARATION:

I/we promise that all information stated in this application is true and accurate, to the best of my/our knowledge. I hereby authorize Lady Bug Franchise Corporation to make inquiries as necessary to determine the accuracy of the statements made above and to determine my creditworthiness. I release Lady Bug Franchise Corporation, its affiliates, agents and employees from any liability arising either from the receipt or use of any information obtained through these sources. In addition, I understand that submission of this application does not, in any way, obligate Lady Bug Franchise Corporation to sign a franchise agreement.

...................................

Applicant Signature

CERTIFICATION

I certify, individually and on behalf of the corporation, limited liability company or other entity named below, that:

1.         I am not, nor to the best of my knowledge have I been designated, a "suspected terrorist," as defined in Executive Order 13224.

2.         To the best of my knowledge, neither such entity, nor its officers, directors, shareholders, members, employees or agents has been designated a "suspected terrorist," as defined in Executive Order 13224, and that such entity is not owned or controlled by a "suspected terrorist," as defined in Executive Order 13224.

SIGNATURE....................................
DATE ....................................

Mail complete application to: LADY BUG FRANCHISE CORPORATION
1641 E. University Drive
Mesa, Arizona 85203

REQUEST FOR FRANCHISE DISCLOSURE DOCUMENT

Dear Madam/Sir:
I request from you information concerning a Lady Bug® Franchise. I recognize and acknowledge that I may receive information that represents trade secrets that are the property of Lady Bug Franchise Corporation. I hereby agree that I will not use or disclose any of the information I receive from Lady Bug Franchise Corporation for any personal benefit or for the benefit of any other person or company without the express written consent of Lady Bug Franchise Corporation.

I am not currently connected in any manner whatsoever with any business or service similar to Lady Bug Franchise Corporation, nor have I been requested or directed to obtain information on behalf of any other company or individual.

Name:
Address:
City :
State :
Zip :
Telephone (home) :
Best time to call :
SIGNATURE.....................................
DATE .....................................
This request, along with the application, must be filled out in its entirety, signed, dated and witnessed before the Franchise Disclosure Document will be sent. Completion of this request, however, does not guarantee that the Franchise Disclosure Document will be sent.

Mail To: LADY BUG FRANCHISE CORPORATION
1641 E. University Drive
Mesa, Arizona 85203