Thank you for exploring a franchise with By-the-Bucket!

Please provide us with info we’ll need, to help you.

We’re thrilled that you’re interested in our brand! To help us serve you better, please take a few minutes to let us know more about you, help us understand your expectations, and attempt to qualify you for franchise opportunities with us. Any information you provide will be held in strict confidence.

Note: This form is not a contract and does not obligate you or us in any way.

Candidate Infomation

Name *

Address

City

State

Zip

Email Address *

Phone Number *

What Led You to Inquire with Us?

Please tell us where you heard about us and why you are interested in a By-the-Bucket Franchise.

About You

Please tell us a little about yourself.

Date of Birth (Month/Day/Year)

Marital StatusMarriedDivorcedDomestic Partnership or Civil UnionCohabitingSingle, Never Married

Spouses Name

Spouses Occupation

Total Dependents

Please describe your general health.

HomeOwnRent

How long have you owned or rented your home?

Brokers & Consultants

Are you using a business broker or consultant?YesNo

If yes, name.

Most Recent Professional Experience

Please tell us about your professional experience over the past five years.

Company

Address

Position

Employed from when to when? (Month/Date/Year)

Describe your responsibilities in this role.

Previous Professional Experience

Please tell us about your professional experience over the past five years.

Company

Address

Position

Employed from when to when? (Month/Date/Year)

Describe your responsibilities in this role.

Education

Highest Level CompletedHigh SchoolUndergraduate DegreeGraduate DegreeOther

If Other, Please Describe

Business Reference #1

Name

Phone

Address

Years Known

Business Reference #2

Name

Phone

Address

Years Known

Personal Reference

Name

Phone

Address

Years Known

Assets

Cash on hand in unrestricted banks

U.S. Government Securities

Notes Receivable

Stocks & Bonds

Real Estate

Life Insurance Cash Surrender Value

Automobile(s) Registered in Your Name

Other Assets

Total Assets

Liabilities

Notes Payable to Banks

Notes Payable to Others

Loans Against Life Insurance

Interest Payable

Taxes & Assessments Payable

Mortgages Payable on Real Estate

Brokers Margin Accounts

Other Liabilities

Total Liabilities

Net Worth

Total Assets minus Total Liabilities

Income

Annual Salary

Bonus & Commission

Dividends & Interest

Real Estate Income

Income from Other Sources

Total Income

Availability

Capital Available to Invest in Franchise

Desired Franchise Location

First Choice

Second Choice

Time Commitment

How much time each week do you intend to spend on this business?

Please explain your other time obligations.

Sources of Cash

How do you intend to fund this operation?

Business Questions

What do you consider your strengths as a business person?

How do you feel about following a proven operating system?

Have you ever failed in business or been compromised with creditors?

If yes, please explain.

Have you ever filed for bankruptcy?

If yes, please explain.

May we run a background check on you?YesNo

Terms & Conditions

This evaluation is for information purposes only and is not a contract or offer of any kind. It is, however, understood that the applicant supplies information herein to the best of his or her knowledge and ability, and By-the-Bucket relies on factual data in assessing the qualifications of each applicant. This evaluation will serve as authorization to complete a credit check and other background evaluations.

Checkboxes *

• I agree to the terms & conditions

Date Submitted (Month/Date/Year) *

Type Name to Sign *

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