Coffix Application Form

Coffix Franchise Application Form

Personal Details

First Name

Last Name

Address, suburb

City

Postcode

Mobile

Date of Birth

Will a partner be involved in the business?

YesNo

If yes, please provide the name explain in what way:

Your hobbies, interests (optional):

Employment & Experience

Briefly list your recent employment (Dates, Position, Responsibilities, Income):

Customer service & managing staff experience?

Education & Qualifications

Have you ever owned a business? (If yes, what type and for how long)

Legal & Health Disclosures

Have you or your partner ever declared bankruptcy or entered into creditor compromise?

Are any lawsuits pending against you or your partner?

Do you or your partner have any criminal convictions? (If yes, provide details)

Do you have any health conditions that could affect your ability to operate the business?

Franchise Enquiry

Where did you hear about Coffix?

Have you visited Coffix outlets, which store?

Why do you wish to own a Coffix Franchise?

Preferred locations for your Coffix store:

Expectations

Do you want to run your Coffix store or consider it as an Investment or speculation?

Time you plan to devote to the business?

Available start date?

Expected initial annual income?

Financial Statement

How much are you planning to invest in the business and how do you plan to finance your franchise?

Do you own a house?

YesNo

Do you have savings > $100,000?

YesNo

Other financial info to disclose:

References

Declaration & Terms

1. The applicant warrants that the information contained in this document is accurate and understands that Coffix Limited relies on it.

2. This application is in no way binding upon either Coffix Limited or the applicant to enter into a Franchise Agreement.

3. The applicant authorises Coffix to check references. Coffix will seek approval prior to checks.

4. Applicant will keep all communications strictly confidential.

I hereby certify that the information provided is true and accurate to the best of my knowledge.

Electronic Signature (Type Full Name)

Date Signed

For manual submission, print and email franchise@coffix.co.nz