Factory Optical | Optiks International

Personal Information

First Name:

Middle Name:

Last Name:

Address:

City:

Province:

Postal Code:

Home Phone:

Work Phone:

Cell Phone:

Email Address:

Birth Day:

Franchise Information

Do you own an existing optical business?:

Will you operate the franchise directly?:

If not, do you have a licensed optician as a partner/ manager?:

Will your spouse be involved in the business?:

Will you have other family members or other partners in the business other than a liscensed optician?:

When are you interested in starting the franchise?

What city / town are you interested in for this franchise?

City/Town 1:

City/Town 2:

City/Town 3:

Financial Information

Cash on Hand:

Investments:

Real Estate:

Automobile(s):

Other Assets:

Sum to Total Assets:

Liabilities

Accounts and Bills Due:

Real Estate Mortgages:

Other Loans:

Lines of Credit:

Other Debts:

Sum to Total Liabilities:

Net Worth

Sum Assets - Liabilities:

Income

Salary plus bonus and commissions:

Spouse’s salary plus bonus and commissions

Other Income:

Total Income (sum of above):

Monthly Expenses:

Free Cash Flow Monthly (total income - monthly expenses):

Bank Information

Institution:

Contact:

Highest Extended:

Business Experience

Present Position:

Company:

Upload Resume:

have you ever owned a franchise before?:

Have you held a people management role before?:

Education (if full resume not attached):

Personal Reference

Name:

Address 1:

Address 2:

Occupation:

Years Known:

Phone Number:

Business Reference

Name:

Address 1:

Address 2:

Relationship:

Occupation:

Years Known:

Phone Number:

Additional Information

Is there anything else you would like us to know about you and to consider as we evaluate your franchise application?:

Marketing Information

How did you find ou tabout Factory Optical / Optiks International?:

Why are choosing to make an application for a franchise with Factory Optical / Optiks International?:

Privacy and Consent Disclosure

Please read and agree to the following:

By Selecting “Yes”, I consent to the collection, use and disclosure of my personal information by Frnachisor during the course of its consideration of my application to become a franchisee of Franchisor and for the purposes set out in Franchisor’s Privacy Policy. In addition, I consent to and accept this as written notice of your obtaining, disclosing or exchanging any credit, personal or other information about me (including information contained in my personal information file) at any time, from, to or with any credit bureau, personal information agent, credit grantor or insurer, my employer or other person in connection with any relationships between us or those which you or I may wish to establish. I also consent to the use and disclosure at any time of all such personal and other information: (i) for the purposes of offering me any other product or franchise of the Franchisor or of it affiliates and suppliers that Franchisor believes may be of interest to me; (ii) to determine which benefits, services or enhancements, and / or which other products or service offers may be of interest to me; and (iii) for such other uses as are not prohibited by law.

Agreement:

Name:

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