Franchises Available

Please Note: This form should be used to apply for franchising consideration only.

Franchises Information

How did you hear about us?

Have you visited Okie Dokie?:

Yes No

I am most interested in:

Single-Unit Operation
Multi-Unit Operations

Location Preference:

List partners:
Please provide name and phone number for each partner

(Individual applications are required on all partners)

Personal Information

Last Name:*

First Name:*

MI:*

Birth Date:**

SS Number:*

Address:*

City:*

State:*

Zip Code:*

Citizenship:

E-Mail:*

Day Time Phone:*

May we Contact you at work?:

Yes No

Evening Phone:*

** must be 18 years or older.

Personal References

Name:

Relation:

City:

State:

Phone:

Education Information

Education Completed:

High School:   College:   Masters  PHD

Education History

School Attended:

Years:

Grade or Degree Attained:

Business Information

Self-Employed  Employed

Present/Past Employer:

Address:

Phone:

Position:

Salary:

Years:

Do you currently own a day care?

Yes No

If yes, Business Name & Type?

Are you currently under Non-Compete Agreement of any kind?

Yes No

Business References

Name:

Company:

Phone:

Financial Information

Income from present Occupation:

per year

Other Income:

per year

Do you own your home?

Yes No

If so, what is the current value?

What is your mortgage balance?

How much capital do you have available to invest in an Okie Dokie Center?

Personal Financial Statement

Cash in Bank:

Notes Payable Bank:

U.S. Gov & Marketable Securities:

Notes Payable Other:

Real Estate Owned: (purchase price)

Real Estate Mortgages:

Automobile & Other Vehicles:

Other Assets:

Total Assets:

Total Liabilities:

Net Worth: (Assets - Liabilities)

Do you have a financing source?

Yes No

If so, in what amount?

Have you had any claims or litigation which you were involved in during the past 5 years?

Yes No

If Yes, Explain:

Have you ever filed for bankruptcy, had a real estate loan foreclosure, or had any liens against you?

Yes No

If Yes, Explain:

Have you ever been convicted of, or plead guilty or "NOLO CONTENDERE" to any Felony Offenses?

Yes No

If Yes, Explain:

Financial Institutions

Name:

Branch:

City:

State:

Phone:

EVERYTHING STATED IN THIS APPLICATION IS TRUE AND ACCURATE, AND I UNDERSTAND THAT THE INFORMATION PROVIDED BY ME WILL BE RELIED UPON BY THE FRANCHISOR, DIEGO & FRIENDS, LLC. ("D&F"). I understand that the granting of a franchise is at the sole discretion of D&F and that acceptance of this Application is not a grant of a franchise. Franchises are granted only by execution of a written Franchise Agreement.

I understand that any information I received from D&F or from any employee, agent, or franchisee of D&F is highly confidential ("Confidential Information"), has been developed with a great deal of effort and expense to D&F, and is being made available to me solely because of this Application. I agree that I shall treat and maintain all Confidential Information as confidential, and I shall not, at any time, without the express written consent of D&F, disclose, publish, or divulge any Confidential Information to any person, firm, corporation or entity, or use any Confidential Information, directly, for my own benefit or the benefit of any person, firm, corporation or other entity, other than for the benefit of D&F.

I authorize the release of any information deemed necessary by D&F to verify any and all of the information contained herein. This authorization for release of information includes but is not limited to matters of opinion relating to my background, mode of living, credit worthiness, character, ability, reputation and past performance. I understand that I have a right upon written request to the franchiser D&F to provide information regarding the nature and scope of such investigation. I authorize all persons, schools, companies, corporation, credit bureaus, and law enforcement agencies to release such information without restriction or qualification to investigatory parties selected by D&F, any of its officers, agents, employees and servants. I voluntarily waive all recourse and release them from liability for complying with this authorization. This authorization and release shall apply to this as well as any future information request. I authorize that a photocopy or facsimile of this authorization and release be considered as valid as the original.

Date:

Confirm this statement with your initials:*

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