confdential questionnaire

Full Name:

Home Address:

Home Tel: Work Tel (if appropriate):

Mobile Tel: Email:

Date of Birth: Nationality: Marital Status:

Number of Children: Ages:

Health (state any serious illness or disability):

Hobbies / Interests / Skills:

Employment Details (give names of employers for the last 5 years, dates, position and any other details you consider relevant.

Attach a full CV if you have one):

P.T.O.

Financial Information:
How much liquid (unencumbered) capital can you raise to invest in your business and how do you propose to raise this?

Do you own your own house? Current market value: Mortgage balance:

Do you have a clean driving licence? Number of points:

Have you ever owned your own business? (give details)

If yes, have you ever been involved in a business which has failed / ceased trading? (give details)

Have you ever been convicted of a criminal oence other than a driving oence? (give details)

Why do you wish to own your own business?

What qualities do you believe are necessary to run a successful franchise?

When would you wish to start your business?

Do you plan to include anyone else in the business? (give details)

Do you have the full support of your spouse and family?

Your preferred geographical area to run an Vitamin Shop franchise would be:

1: 2: 3:

I understand that the above information will be kept in strictest condence by Vitamin Shop Ltd and hereby warrant that the in formation is true and accurate to the best of my knowledge and that my signature below constitutes no obligation by Vitamin Shop Ltd or myself to enter into a franchise agreeme nt.

Signed: Date:

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