"*" indicates required fields Personal InformationDate* Month Day Year Name* First Last DOB* Month Day Year Spouse's Name First Last DOB Month Day Year Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone*Office PhoneCell PhoneEmail Address* Are you a U.S. citizen?* Yes No If not, are you a U.S. resident alien? Yes No If, not, what is your visa status?Education HistoryHigh SchoolYears Completed 1 2 3 4 Name(s) of college, graduate school, address, degree earned, years attended and major subjects.SchoolAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Years AttendedDegreeMajor(s)SchoolAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Years AttendedDegreeMajor(s)Employment HistoryDescribe your last two occupations (indicate if self-employed)Present PostionFrom/ToCompany Name/LocationType of BusinessSupervisorCan we contact him/her? Yes No PhonePrevious PostionFrom/ToCompany Name/LocationType of BusinessSupervisorCan we contact him/her? Yes No PhoneBusiness and ManagementDo you have restaurant management experience? Yes No If yes, explain.Have you ever been a franchisee of any other company? Yes No If so, what company and dates?May we contact them? Yes No NamePhoneDo you plan to be a full-time operator of this business? Yes No If not , have you identified a vested operating partner? Yes No What in your background or experience qualifies you to be a Honey Dew Donuts ® Franchisee?How will becoming a Honey Dew Donuts ® Franchisee help you in achieving your business and personal goals?ReferencesName #1PhoneRelationship# Years KnownName #2PhoneRelationship# Years KnownName #3PhoneRelationship# Years KnownDo you plan to have an equity partner? Yes No If yes, please identify all partners:Name #1AddressPhoneActive in business? Yes No Name #2AddressPhoneActive in business? Yes No Name #3AddressPhoneActive in business? Yes No Name #4AddressPhoneActive in business? Yes No Name #5AddressPhoneActive in business? Yes No Who will run your operation day-to-day?Do they have restaurant management experience? Yes No What is their current responsibility?Have they supervised others previously? if so, how many and in what capacity.Planned date to open first unit: Month Day Year Are you interested in multi-unit development? Yes No Site InformationDo you own a site? Yes No Location preferred:First ChoiceSecond ChoiceThird ChoicePreliminary Financial InformationLiquid assets availableSource of funds: Complete attached financial statement Attach photocopies of documents verifying amount shown above Other InformationPlease include the following: Resume(s) of management personnel Verification of liquid assets I authorize Honey Dew Associates, Inc. to investigate my character and abilities and to contact anybody, whether specifically listed in this application or not-including former employers-as a means of learning personal information regarding my background. I allow all parties contacted on my behalf of Honey Dew Associates, Inc., to share this information. Also, by signing below, I acknowledge that all information in this application is true and complete. Should the enclosed information be incomplete, if will be returned, delaying the review process.Signature*Date* Month Day Year Signature of SpouseDate Month Day Year Financial StatementAssets (A)Cash **Stocks (list in Schedule 1) **Retirement Accts (401k, IRAs)Personal PropertyAutomobilesHome (list on Schedule 2)Other Residences (list on Schedule 2)Real Estate (list on Schedule 2)Rental Properties (list on Schedule 3)Business AssetsOther assets (list)list 1List 1 valuelist 2List 2 valuelist 3List 3 valueTotal Assets (A)Liabilities (B)Credit CardsAutomobilesSecured LoansUnsecured LoansTaxesHome MortgageOther Mortgages #1Other Mortgages #2Other Debts (iternize)Other Debts #1Other Debts #1Business LiabilitiesTotal Liabilities (B)Net Worth (C) (A - B)Total (D) (B + C)Source of Annual IncomeSalaryBonus and CommissionsDividendsReal Estate IncomeOther Income (Itemize)Other Income #1Other Income #2Total Annual IncomeEstimate of Annual ExpensesMortgage PaymentsRentAutomobile Payments/LeasesInsurance PremiumsTaxesOther ExpensesTotal Annual ExpensesGeneral InformationPersonal bank accounts carried at:Are any assets pledged? Yes No If yes, please explain.Do you have contingent liabilities? Yes No If yes, please explain.Are you a defendant in any legal actions? Yes No If yes, please explain.Have you ever filed for bankruptcy or had proceedings commenced against you?? Yes No If yes, please explain.**Please attach copies of recent bank and/or brokerage statements verifying liquid assets.Max. file size: 20 MB. Schedule 1 - Stocks, Bonds and SecuritiesDescriptionNumber of SharesBond-Face ValueMarket ValueDescription #1Number of Shares #1Bond-Face Value #1Market Value #1Description #2Number of Shares #2Bond-Face Value #2Market Value #2Description #3Number of Shares #3Bond-Face Value #3Market Value #3Description #4Number of Shares #4Bond-Face Value #4Market Value #4Description #5Number of Shares #5Bond-Face Value #5Market Value #5Schedule 2 - Real Estate OwnedDescriptionMarket ValueTerms/Maturity/BalanceMonthly PaymentDescription #1Market Value #1Terms/Maturity/Balance #1Monthly Payment #1Description #2Market Value #2Terms/Maturity/Balance #2Monthly Payment #2Description #3Market Value #3Terms/Maturity/Balance #3Monthly Payment #3Description #4Market Value #4Terms/Maturity/Balance #4Monthly Payment #4Description #5Market Value #5Terms/Maturity/Balance #5Monthly Payment #5Schedule 3 - Rental PropertiesDescriptionMarket ValueBalance and PaymentRent ReceivedDescription #1Market Value #1Balance and Payment #1Rent Received #1Description #2Market Value #2Balance and Payment #2Rent Received #2Description #3Market Value #3Balance and Payment #3Rent Received #3Description #4Market Value #4Balance and Payment #4Rent Received #4Description #5Market Value #5Balance and Payment #5Rent Received #5List Names of Firms Where Credit Has Been ObtainedLenderAmountLender #1Amount #1Lender #2Amount #2Lender #3Amount #3Lender #4Amount #4Lender #5Amount #5By signing below I am stating the above information is accurate and I agree to advise Honey Dew Associates, Inc. if there is a material change prior to my execution of franchise closing documents. Additionally, the undersigned acknowledges that Honey Dew Associates, Inc. may check my credit, employment history, reports from consumer reporting agencies, and may run a criminal background check in order to determine my creditworthiness and suitability for a franchise. I hereby authorize persons or entities from whom such information is requested to provide same.Signature*Date Month Day Year Signature of SpouseDate Month Day Year
