Franchise Application Form

Old Hippy invites you to join the furniture and design industry!

Old Hippy furniture is built to last, destined to become family heirlooms that can be passed down to future generations. If you love furniture and interior decorating, an Old Hippy Franchise is perfect for you.

Old Hippy Wood Products Inc. 2415 - 80 Avenue, Edmonton, Alberta, Canada T6P 1N3 Toll Free:1-888-464-9700 Fax:1-780-435-5475

Franchise Application Questionnaire

This questionnaire does not obligate either party in any manner.

Name *

Email * * (fields required)

Address

City / Town

Province / State

Postal Code / Zip Code

Phone Home *

Phone Work

Mobile / Cell

Birth Date:

Married Spouse's Name Single

How soon would you like to open your business? (month / year)

What level of income do you expect / require from this business?

What unencumbered investment would you contribute to the business?

What total inventory investment would you like to make in this business?

$100,000 - $150,000 $150,000 - $200,000 $200,000 - $250,000

EMPLOYMENT HISTORY:

Present name of Employer and Supervisor

Address Date of Employment

Position Present Salary

Previous Employer and Supervisor

Address Date of Employment

Position Final Salary

Other Comments or Questions...

Applicants Personal Financial Statement

Assets

Cash on Hand

Securities

Accounts and Loans Receivable

Real Estate

Other Assets (itemized):

TOTAL ASSETS

Liabilities

Mortgages:

Home

Real Estate

Other

Loans:

Notes Payable:

Note:

Note:

Other Liabilities:

TOTAL LIABILITIES

TOTAL ASSETS

TOTAL LIABILITIES

NET WORTH

I understand that the granting of a Franchise is at the sole discretion of the Franchisor, Old Hippy Wood Products Inc.. I understand that all information I am receiving from the Franchisor or from any employee, agent, or Franchisee of the Franchisor is highly confidential, is being made available to me because of this application, and will be held in the strictest of confidence.
I will not divulge or use any data, customer or employee names and addresses, techniques, methods, advertising materials, forms, or other information of whatever kind received from the Franchisor to any person or company without the written consent of Old Hippy Wood Products Inc..
I authorize the procurement of an investigative consumer report and understand that it may contain information about my background, character, general reputation, mode of living, credit worthiness, and job performance. I understand that, upon written request within a reasonable period of time, I am entitled to additional information concerning the nature and scope of this investigation. I hereby release Old Hippy Wood Products Inc. from any liability arising from the preparation of this report or investigation relating thereto.
This authorization for release of information includes but is not limited to matters of opinion relating to my character, ability, reputation and past performance. I authorize all persons, schools, companies, corporations, credit bureaus and law enforcement agencies to release such information without restriction or qualification to Old Hippy Wood Products Inc. and any of their officers, agents, employees and servants. I voluntarily waive all recourse and release them from liability for complying with this authorization. This authorization/release shall apply to this as well as any future request for an investigative consumer report by the above named firm. I authorize that a email, photocopy or facsimile of this release be considered as valid as the original.
* I have read this application and everything I have stated in it is true. Additionally, I understand that the information provided by me will be relied upon by the Franchisor. * (fields required)