DOLLARCASTLE


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Personal Information

First Name:	Middle Name:	Last Name:

Are you a US Citizen?:	If no, what country?:	Date of Birth:
Yes No		(MM/DD/YYYY)

Residence Address:	City, State:	Zip Code:
	,

How long have you lived at this address?:

Best Phone Number to reach you:	Home Phone:

Cell Phone:	Fax:

Email Address:	Are you married?
Best Time To Call You? (Example: 4pm-6pm)	Yes No If Yes, Please list spouse name:

Education

High School: (Highest grade or degree attained)	Junior College/Tech: (Highest grade or degree attained)	College: (Highest grade or degree attained)

General Information

Have you ever visited a Dollar Castle®?:

What is your timeline for getting started?

Yes No

Do you have retail experience?:

What kind of experience?:

Yes No

Are you looking to run the business yourself?:

Will you have other owners/partners?:

Yes No

If yes, who are they?:

Why do you desire to join the Dollar Castle team?:

What city or town are looking to develop a Dollar Castle in?:

1st Choice:
2nd Choice:

Are you looking for a single store development?:

Are you looking to become an area developer?:

Yes No

How did you hear about Dollar Castle?:

Employment Information

Are you:	Or are you:
Employed Self Employed Please answer employment questions below.	Unemployed Retired
Name of Company/Employer:	Type of Business:

Position:

Name of Company/Employer:	Type of Business:

Position:

Name of Company/Employer:	Type of Business:

Position:

Assets

Total Liquid Assets Available: (e.g. cash, stock, bonds, mutual funds)	Total Tangible Assets: (e.g. house, car, business, etc.)
($60,000 Liquid Capital Required)
Total Liabilities:
	($216,550 Total Net Worth Required)
If you don't meet our financial requirements we ask that you explain how you will fund your Dollar Castle business:

Legal Information

Are you currently involved in any lawsuits?:	Have you ever filed for bankruptcy protection?:
Yes No	Yes No
If yes, identify discharge date:	(MM/DD/YYYY)
Are you or anyone in your immediate family a partner or owner (partial or otherwise) of a discount retailing business?:	If yes, list name of business and family relationship:
Yes No
Are you or anyone in your immediate family employed by a discount retailing business?:	If yes, list name of employer and family relationship:
Yes No
Are you or anyone in your immediate family currently under any form of non-competition agreement that limits your right to operate any business?:	If yes, list name of employer and family relationship:
Yes No
Have you ever been convicted of a felony?:
Yes No

References (Please complete all three entries.)

Name:	Relation of this person to you:

Years you have known this person:	Phone Number and Area Code:

Name:	Relation of this person to you:

Years you have known this person:	Phone Number and Area Code:

Name:	Relation of this person to you:

Years you have known this person:	Phone Number and Area Code:

Terms & Conditions

I understand that the granting of a franchise is at the sole discretion of the Franchisor (Dollar Castle) I understand that the information I am receiving from Dollar Castle, or from any Dollar Castle associate, employee, agent, or franchise is highly confidential, has been developed with a great deal of effort and expense to Dollar Castle, and is being made available to me because of this application, and will be held in strictest 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 without consent. 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 Dollar Castle, its representatives, and their officers, agents, employees and servants from any liability arising from or relating to 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, financial institutions, credit agencies and bureaus, courts, and law enforcement agencies to release such information without restriction or qualification to Dollar Castle, its representative, or any of their officers, agents, employees and servants. I voluntarily waive all recourse and release them from liability for complying with this authorization, and I hereby realize Dollar Castle, and its representatives, and their officers, agents, employees, and servants, from any liability on account of the provision of such information or the use of such information in connection with this application. This authorization/release shall apply to this as well as any future request for an investigative consumer report by Dollar Castle I authorize that a 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 the filing of this application does not obligate me the applicant to purchase or the franchisor to sell a franchise. I understand that the information provided by me will be relied upon by the Franchisor. I certify that the statements in this application are complete, and I have not withheld information affecting my reputation or credit standing.

I accept the above terms:

Yes No