Confidential info Please enable JavaScript in your browser to complete this form.Name *FirstLastPERSONAL INFORMATIONMiddle Initial PERSONAL INFORMATIONOccupation PERSONAL INFORMATIONAddressPERSONAL INFORMATIONPrevios AddressPERSONAL INFORMATIONHome PhonePERSONAL INFORMATIONCell PhonePERSONAL INFORMATIONEmail *PERSONAL INFORMATIONName of Spouse FirstLastPERSONAL INFORMATIONOccupation of Spouse PERSONAL INFORMATIONName of Employer BUSINESS EXPERIENCE Position/Title BUSINESS EXPERIENCE Salary BUSINESS EXPERIENCE Name of Employer BUSINESS EXPERIENCE Position/Title BUSINESS EXPERIENCE Salary BUSINESS EXPERIENCE Name of Employer BUSINESS EXPERIENCE Position/Title BUSINESS EXPERIENCE Salary BUSINESS EXPERIENCE Name of School EDUCATIONMajor EDUCATIONDates of Attendance EDUCATIONDegree/Diploma EDUCATIONName of School EDUCATIONMajor EDUCATIONDates of Attendance EDUCATIONDegree/Diploma EDUCATIONAre you legally allowed to work in the U.S. YesNo ABOUT YOUHave you ever filed for bankruptcy YesNo ABOUT YOUHave you ever been convicted of a felony?YesNo ABOUT YOUIf yes explain why ABOUT YOUWill you be a “hands on” operator of your Complete Feet franchise? Describe your planned role in the operation of the business. Include if you are currently a Pedorthist or have plans to become licensed. ABOUT YOUList the areas you are interested in operating your Complete Feet franchise. ABOUT YOUList the areas you are interested in operating your Complete Feet franchise. ABOUT YOUList the areas you are interested in operating your Complete Feet franchise. ABOUT YOUHave you ever owned a business Yesno ABOUT YOUIf yes, what type? ABOUT YOUDates ABOUT YOUCash-Checking accountsFINANCIAL STATEMENTCash-Savings accountsFINANCIAL STATEMENTCertificates of DepositFINANCIAL STATEMENTSecurities-Stocks/Bonds/Mutual FundsFINANCIAL STATEMENTNotes and Contracts receivablesFINANCIAL STATEMENTLife insurances (cash surrender value)FINANCIAL STATEMENTPersonal property (autos, jewelry, etc.)FINANCIAL STATEMENTRetirement funds (IRA’s, 401k)FINANCIAL STATEMENTReal Estate (market value)FINANCIAL STATEMENTOther assets (specify)FINANCIAL STATEMENTTotal Assets FINANCIAL STATEMENTCurrent debt (credit cards, accounts)FINANCIAL STATEMENTTaxes payableFINANCIAL STATEMENT Real Estate mortgagesFINANCIAL STATEMENTNotes payable (describe below)FINANCIAL STATEMENTOther liabilities (specify)FINANCIAL STATEMENTOther liabilities (specify) FINANCIAL STATEMENTOther liabilities (specify) FINANCIAL STATEMENTTOTAL LIABILITIESFINANCIAL STATEMENTNET WORTH (ASSETS-LIABILITIES)FINANCIAL STATEMENTAddressCurrent Real estate Date Purchased Current Real estate Purchase PriceCurrent Real estate Mortgage of Liens Current Real estate Amount of Payments Current Real estate Present Market ValueCurrent Real estate Address Current Real estate Date Purchased Current Real estate Purchase Price Current Real estate Mortgage of Liens Current Real estate Amount of Payments Current Real estate Present Market Value Current Real estate Name of creditor CURRENT DEBT/NOTES PAYABLEAmount owed CURRENT DEBT/NOTES PAYABLEAge of debtCURRENT DEBT/NOTES PAYABLEDescription of debtCURRENT DEBT/NOTES PAYABLEDescription of security held CURRENT DEBT/NOTES PAYABLEDue Date CURRENT DEBT/NOTES PAYABLEName of creditor CURRENT DEBT/NOTES PAYABLEAmount owed CURRENT DEBT/NOTES PAYABLEAge of debt CURRENT DEBT/NOTES PAYABLEDescription of debt CURRENT DEBT/NOTES PAYABLEDescription of security held CURRENT DEBT/NOTES PAYABLEDue Date CURRENT DEBT/NOTES PAYABLEDISCLAIMER AND SIGNATUREIn submitting the foregoing information, the undersigned guarantees information as complete and true personal and financial condition as of the date shown. The undersigned understand that Complete Feet Franchising, LLC. is relying upon all the above information as material factor in considering application for a franchise agreement. This is not a contract; supplying or completing this form incurs no obligation on either party. The undersigned understands that prior to awarding a franchise agreement, Complete Feet Franchising, LLC., will conduct a credit and criminal background check. At the appropriate time prior to awarding a franchise agreement, the undersigned, will be required to provide the necessary information and approval to conduct such investigations. Offering is made by prospectus only.DateDISCLAIMER AND SIGNATUREIn submitting the foregoing information, the undersigned guarantees information as complete and true personal and financial condition as of the date shown. The undersigned understand that Complete Feet Franchising, LLC. is relying upon all the above information as material factor in considering application for a franchise agreement. This is not a contract; supplying or completing this form incurs no obligation on either party. The undersigned understands that prior to awarding a franchise agreement, Complete Feet Franchising, LLC., will conduct a credit and criminal background check. At the appropriate time prior to awarding a franchise agreement, the undersigned, will be required to provide the necessary information and approval to conduct such investigations. Offering is made by prospectus only.DateWebsiteSubmit