Full Name: Social Security #:
Address:
City: State: Zip:

Home Phone: ( ) - Work Phone: ( ) -
Best Time & Place to Call: Home Work
Driver's License Number: State: Date of Birth: Marital Status:
If married, spouse's Name: Social Security #: Date of Birth:
Children (names & ages):

What is your timeframe for committing to this venture, specifically the signing of a franchise license?

1 to 3 months 3 to 6 months Over 6 months

Please list your metropolitan market(s) of interest and indicate if you are able to relocate to other market areas.

1st choice..
2nd choice
3rd choice. Can relocate: Yes No

BACKGROUND INFORMATION (Resume or other business summary may be attached.)

Current Employer: Type of Business:
Dates, From: To: Last Position Held:
Address:
City: State: Zip:
May we check your references? Yes No Contact Person:
Education: High School (yrs.) _____ 4 3 2 1 0 College (yrs.) 4 3 2 1 0 5 6 7 8 Degree(s)
Name of College:
Vocational or Specialized Training:

Have you ever owned a Business? Yes No

Business Name: Nature of Business:
Address:
Years in Business: From: To:
Business Name: Nature of Business:
Address:
Years in Business: From: To:

REFERENCES

Professional Reference – list a supervisor, colleague or other person who is familiar with your work history.
Name: Position:
Company:
Address:
Telephone: ( ) -

Personal Reference - please list someone, other than a relative, who has known you for over three years.
Name: Affiliation With You:
Address:
Telephone: ( ) -

GENERAL INFORMATION
(Answering “yes” or “no” to these questions does not constitute an automatic bar to approval of the application. Factors such as the date of the incident, seriousness and nature of the violation will be taken into account.)

Have you ever filed bankruptcy or for protection from creditors in the past seven years? ..
Yes No If yes, please state the date and details:

Have you or your business had any judgements or liens filed against you in the past seven years?
Yes No If yes, please state date and details:

Have you ever been convicted of a felony or misdemeanor (other than a minor traffic violation)? .
Yes No If yes, please state the date and details:


Have you or any member of your family ever been affiliated with or employed by More Space Place® or any ts franchises?
Yes No If yes, please state the date and details:

Will you devote your full time to this business?
Yes No If not, give your intentions as to the division of your time.

Will any other family member be directly involved in the daily operation of this business?
Yes No If yes, list whom and in what capacity.

OTHER PARTIES TO BE INVOLVED IN THIS BUSINESS
(Any potential partner/owner must complete an application.)

Name:_____ Telephone: ( ) -
Association: Partnership Percentage:
Address:___
City:______ State: Zip:

Current Occupation and/or Employer:
Number of years in current industry or with this employer:

OTHER PARTIES TO BE INVOLVED IN THIS BUSINESS

Name:_____ Telephone: ( ) -
Association: Partnership Percentage:
Address:___
City:______ State: Zip:

Current Occupation and/or Employer:
Number of years in current industry or with this employer:

SOURCE OF FUNDS
You must provide copies of statements for verification of your cash investment funds from your financial institution(s).
Cash investors with no ownership and management interest in the franchise must submit a letter of commitment
stating how much they are contributing, where the funds are coming from and their anticipated participation level.
Partners, shareholders and anyone who will have any ownership interest in the franchise must complete a separate
application.

How much do you anticipate investing from your own funds? $

How much financing do you anticipate securing? $

If you anticipate securing financing, what is the source of the financing?

ANNUAL INCOME/NET WORTH

*Use of marketable securities as part of your cash investment source indicates that you are prepared to liquidate
these securities upon the approval of your application.

**The assets you indicate that are designated for your personal cash investment (in addition to funds committed by
any additional investors) must be equal to or greater than the amount you have indicated as your portion of the
source of funds.

Thank you for your Request for Consideration. All information supplied by you will be treated in a strictly confidential manner. You understand that the information submitted to More Space Place, Inc. is material to your evaluation as a potential franchisee, and are therefore certified by you as true in substance and correctly given. The undersigned hereby authorizes More Space Place, Inc. to undertake such investigation and verifications as deemed necessary to substantiate the facts herein supplied.


__________________________________________________________________________________________________
Applicant Signature___________________________Print Name_________________________ _______Date

__________________________________________________________________________________________________
Spouse Signature_____________________________Print Name_________________________ _______Date

Authorization For Release Of Information For Background Investigation

In consideration of my application for employment (including contract for services) with More Space Place (#111-02-0278), I authorize The Omnia Background Search, a Florida corporation and specialist in background checks and hereinafter referred to as OBS, acting on its own or as an agent of any other company or organization and their respective agents, to conduct and report research and share with each other, information about my background including, but not limited to, information about my prior employment, education, driving record, consumer credit history, criminal record, workers compensation claims and general public records history.

Further, I understand that an investigative consumer report may be requested from various Federal, State, Local and other agencies. I understand that such an investigative report may contain information about my background, mode of living, character and personal reputation; and that I am entitled to be advised of the nature and scope of the investigation requested within a reasonable time after I ask for this information in writing.

I HEREBY AUTHORIZE, WITHOUT RESERVATION, ANY PERSONS, AGENCY OR OTHER ENTITY CONTACTED BY OBS TO FURNISH THE ABOVE-MENTIONED INFORMATION.

I understand that any investigative consumer report requested will be used strictly for employment purposes as defined under the Fair Credit Reporting Act §603(h), as a report to be used for the purpose of evaluation for employment, promotion, reassignment or retention as an employee. I understand that OBS, in agreement with its client, does not engage in the marketing or reselling of personal information. I release More Space Place and Omnia Background Search, their respective officers, directors, employees and agents, and all persons, agencies, and entities providing information or reports about me from any and all liability arising out of the release of any such information or reports.

The information requested below is needed for the purpose of positive identification and to complete verification procedures (Please print clearly).

__________________________________________________________________________________________________________
Applicant Signature__________________________________________ Print Name_______________________Date