Please complete the form below: TO BE CONSIDERED AS THE OWNER OF A HAPPY & HEALTHY FRANCHISE, PLEASE COMPLETE THE FOLLOWING APPLICATION Date * County you live in * Name(s) - first, last name * Address * City * State * - - Choose One - - Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Email Address * Web Address * Home Phone - include area / country code * Business Phone - include area / country code * Best place and time(s) to reach you by phone Birth Date * Age * Marital Status * Married Single Seperated # of Dependent(s) * 0 1 2 3 4 5 6+ Age (s) Spouse's Name Spouse's Current Employment Spouse's Birth Date Spouse's Age * Dependent(s) Dependents Age(s) Where did you hear about this business opportunity? (Please be specific) What first attracted you to our company? List 3 Character References Name/Address/Day Time Phone Number & Occupation Character Reference #1 * Character Reference #2 * Character Reference #3 * Employment during the last 5 years. List present or last job first. Employer Duties Salary/Month From - To Employer Duties Salary/Month From - To Employer Duties Salary/Month From - To How do you feel your business and/or job experience would help you run your own business? FINANCIAL INFORMATION Do you own your own Residence? * Yes No How long have you owned it? Name of Bank or Banks where you have accounts: Including stocks, bonds and their value. Bank Name / Address Type of Account Current Balance Bank Name/Address Type of Account Current Balance List approximate value of stocks and bonds you own * Your estimated total taxable income for the last 3 years Year * $ * Year * $ * Year * $ * List 3 Credit References Name/Address Type of Credit Name/Address Type of Credit Name/Address Type of Credit Please fill in Social Security Number for each party involved SSN SSN SSN Do you plan to manage your Franchise personally? * Yes No Will you have a partner in this business? * Yes No How much will partner invest? Will this partner be active in this business? Yes No What driving radius are you willing to service from your home? * 10 or less miles 30 or less miles more than 30 miles Who would primarily run the business? * How flexible are your work hours? * How much capital are you in a position to invest? * State your approximate financial net worth * Additional pertinent financial information (if any) AVAILABILITY When will you be available to open this business? * What would be your first two choices of geographic area? Geographic Choice #1 * Geographic Choice #2 * GENERAL INFORMATION As an organizer and a doer, I consider myself * Above Average Average Below Average My ability to work independently without relying on others is, in my opinion * Above Average Average Below Average My ability to teach and counsel others is * Above Average Average Below Average I feel that my self-starting talents are * Above Average Average Below Average My level of desire to own a business is * Above Average Average Below Average My ability to communicate with people from all walks of life is * Above Average Average Below Average My patience when dealing with less qualified people is * Above Average Average Below Average My thoroughness in completing any task is * Above Average Average Below Average My cooperation in following guidance offered is * Above Average Average Below Average GOALS My annual income goal is * If necessary, to reach my income goal I would be willing to work this maximum number of hours per day * PRIORITIES Please rank the following items in order of importance to you A. Income * 1st Importance 2nd Importance 3rd Importance 4th Importance 5th Importance B. Location * 1st Importance 2nd Importance 3rd Importance 4th Importance 5th Importance C. Independence (desire to operate own business) * 1st Importance 2nd Importance 3rd Importance 4th Importance 5th Importance D. Job Satisfaction * 1st Importance 2nd Importance 3rd Importance 4th Importance 5th Importance E. Opportunity (desire to develop an organization) * 1st Importance 2nd Importance 3rd Importance 4th Importance 5th Importance We appreciate your interest in Happy & Healthy Products, Inc. It is understood that the purpose of this application is for general information, which does not obligate you or H&H in any way. I certify that the above information supplied by me is true and correct. I authorize release of any information deemed necessary by H&H to verify any and all of the above information. I hold H&H harmless for any damages arising from verification of the information contained therein.