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Just-A-Buck


Please fill out our secure franchise application form:
  Your Name
 
  
(Prefix)
  
(First Name)
  
(M.I.)
(Last Name)
  Personal Data
 
Address   
    
City / State / Zip   
Home Phone
Business Phone
Fax
E-Mail Address
Social Security #
Date of Birth
Spouse's Name
# of Dependents  
  Business Experience
From To Firm Position Annual
Income
 
  Exact nature of business experience including self employment:
 
 
  Have you ever failed in business or compromised with creditors?
   Yes   No
  If yes, when, where, circumstances (including any remaining liabilities):
 
 
  Are there any lawsuits pending against you?
   Yes   No
  If yes, please give particulars:
 
  Education
   High School   Some College   4 Years/Graduate
  Financial Data
 
Cash   
Readily Negotiable Securities   
Fair Market Value of Real Estate Above Mortgages     
Liquid Equity in Business Ventures   
Other   
Total Assets   
Liabilities Other Than Mortgages Deducted Above   
Total Liability   
Net Worth   
  Please describe assets from above:
 
 
Personal Bank Reference     
Business Bank Reference   
  Will a family member or anyone else be active in this business with you?
   Yes   No
  Where and When
 
When would you be able to start this venture?   
Are you prepared to devote full time to this business?  Yes   No
Territory in which you are interested?   
  Would you accept an alternate territory if your first choice is not available?
   Yes   No
  How did you hear about the Just-A-Buck franchise? (please be specific)
 
  Comments
  Please use this space to tell us anything else which you think is relevant, such as family business history, your personal business objectives, tax considerations, business ventures in which you have participated.
 
   
  I hearby give Just-A-Buck Licensing, Inc. and their duly authorized representatives permission to check the above references and to make a credit check with the credit bureau in any county or municipality where I have lived or worked or where they feel such a check is necessary.
   Agree   Disagree
 
     
 
  Thanks again for spending time on site with Just-A-Buck.
Here's hoping the bucks start here!
 
 
Contact Us
Here
Just-A-Buck
563 Temple Hill Road
New Windsor, NY 12553
Copyright 2005 All Rights Reserved
Tel:  845-561-7411
Fax: 845-561-7433