Name
*
First Name
Last Name
Date of Birth
MM
DD
YYYY
National Insurance Number
Marital Status
Married
Single
Common law
Partner
Civil partnership
Separated
Divorced
Widowed
Name of spouse/partner
First Name
Last Name
Number of children, ages and names
Home Telephone
Mobile Telephone
Number of years at home address
Home ownership
Owner
Rented
Have you ever been self employed?
If Yes, please give details
Have you had or are you suffering from any serious illness?
If Yes, please give details
Have you ever been declined life, accident or health insurance?
If Yes, please give details
Have you ever been convicted of any charge other than a minor traffic offence?
If Yes, please give details
What age did you leave school?
Name of your last school?
Did you attend college/ higher education?
If Yes, please give Name of Institution and Qualification achieved
How did you hear about the Nugelato franchise?
Have you ever visited a Nugelato Ice cream boutique?
If Yes, Where?
Do you know personally anyone involved in the company?
Do you know any of our franchise partners?
Are you willing to devote your full time and attention to the proposed operation?
If No, please explain why
Nugelato® Boutique Location – First Choice
Nugelato® Boutique Location – Second Choice
Nugelato® Boutique Location – Third Choice
What size of business would you aspire to?
Single boutique
Two boutiques
Multiple boutiques
Please describe briefly what is motivating you to consider the Nugelato® franchise opportunity
What are your financial expectations from Nugelato? (How much profit do you expect to make?)
Notes
Notes
Bank Name
Bank Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Bank Contact
First Name
Last Name
Is your bank aware of your intentions with regard to Nugelato?
Firm Name
Solicitor Name
First Name
Last Name
Solicitor Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Are you able to commit a minimum of £100,000 to the venture from your own resources?
How is this capital being funded?
Is there any reason why you would not be able to finance the balance required?
Source of Funds
Savings
Bank Loan
Other
Does your spouse/ partner contribute to household expenses?
Reference 1 Name
First Name
Last Name
Reference 1 Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Telephone
Reference 2 Name
First Name
Last Name
Reference 2 Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Telephone
Business Name
Business Address 1
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Telephone
Length of Business Association
0 - 1 year
1 - 2 years
2 - 3 years
3 - 4 years
4 - 5 years
5+ years
Business Name
Business Address 2
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Telephone
Length of Business Association
0 - 1 year
1 - 2 years
2 - 3 years
3 - 4 years
4 - 5 years
5+ years
Firm Name
Accountant Name
First Name
Last Name
Accountant Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Business Name
From
MM
DD
YYYY
To
MM
DD
YYYY
Your Position
Brief description of firm’s activities
Business Name
From
MM
DD
YYYY
To
MM
DD
YYYY
Your Position
Brief description of firm’s activities
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