Franchise Application Form

Name*

First Middle Last

Address*

Street Address City Province Postal Code

Is your home

Specify

Phone

Residence	Business	Mobile

Email

Personal Information

Date of Birth

Social Insurance Number

Are you a Citizen of Canada*

If not, what country?

Do you have a valid Driver’s License?

Marital Status

# of Children at Home

Name of spouse

First Middle Last

Spouse’s Date of Birth

Spouse's Social Insurance Number

Education

List

Click on the (+) to add a row

Last Level of Education Completed	Name of Institution and City/Country	Dates Attended	Diploma/Designation/Degree Obtained

Describe any Special Training

Click on the (+) to add a row

Employment History

Are you presently employed?

List business employment for the past five (5) years commencing with the most recent position. Please include a copy of your most recent Resume.

Click on the (+) to add a row

Employer	Position	Employed From	Responsibilities	Most Recent Annual Income

General Information

How did you find out about the franchise opportunity with Fire-Alert?

Have you been employed in the fire and safety services industry? If yes, please provide details:

Have you ever owned your own business, been self-employed, or had involvement in a business venture? If yes, please provide details:

Have you ever filed for bankruptcy?

When?

What level of income do you require/expect to draw from the business per month?

Do you presently have an alternate source of monthly income?

Please provide details:

Will you have a business partner?

Partner’s Involvement

Full-time
Part-time
Investor Only

What level of income will your partner expect/require to draw from the business per month?

Are you able to invest time over the next thirty (30) days to research this opportunity, so that in a month from now, you are able to make an informed business decision?

When would you be able to start?

Location Preference

List Names of Cities/Province

Click on the (+) to add a row

City	Province

Personal Financial Statement

The following is a statement of all of my assets and liabilities as of the

Assets

Cash on Hand & in Bank

Retirement Accounts

Marketable Securities

Life Insurance

Cash Other Liabilities Surrender Value

Real Estate

Describe

Accounts, Loans & Notes Receivable

Business Interests

Other Assets, i.e. Vehicles

Describe

Total Assets (A)

Liabilities

Mortgage(s)

Describe

Description	Monthly Installment

Loan(s)

Describe

Description	Monthly Installment

Other Liabilities

Describe

Total Liabilities (B)

Net Worth (A-B)

Total Assets less Total Liabilities

Equity available to invest in a Fire-Alert franchise

Please itemize the assets that you would convert to cash if necessary, to meet the investment requirement.

Include a copy of supporting documentation

Accepted file types: pdf, doc, docx, Max. file size: 8 MB.

Please itemize present sources of income, i.e. salary, spouse’s salary, real estate income, other income, etc.

References

Include one bank reference. Do not include relatives

References

Click on the (+) to add a row

Name	Address	Telephone	Relationship	Years Known

When submitting the completed Franchise Application Form, please ensure that you have attached:

1. A copy of your Resume;
2. Supporting documentation regarding the investment requirement, i.e. recent bank statement(s), investment statement(s), etc.
3. Recent Equifax Credit Report – Please visit www.equifax.ca to request your online report.

I hereby certify that all of the information provided in this Franchise Application Form is true and correct. I hereby acknowledge that the foregoing information is provided to Fire-Alert Franchising Ltd. for the purpose of determining my suitability for a possible franchise opportunity and hereby authorize Fire-Alert Franchising Ltd. to make such enquiries as may be required, to verify the information provided, including conducting credit reference checks. I hereby consent to the use and disclosure by Fire-Alert Franchising Ltd. of my personal information as may be necessary to undertake such enquiries and verifications. I understand that all information concerning this Franchise Application Form shall remain confidential.