Form

TO BE CONSIDERED AS THE OWNER OF A "HAPPY & HEALTHY"® FRANCHISE, YOU MUST COMPLETE THIS APPLICATION IN FULL. PLEASE DO NOT LEAVE ANY BLANKS.

Date	County you live in

Name(s) - first, last name

Address

City

State

Zip

Email Address

Web Address

Home Phone - include area / country code

Business Phone - include area / country code

Best place and time(s) to reach you by phone

Birth Date

Age

Marital Status

married
single
separated

# of Dependent(s)

Age (s)

Spouse's Name

Spouse's Current Employment

Spouse's Birth Date

Age

Dependent(s)

Age

PARTNERS NAME OR NAMES (IF PARTNER IS OTHER THAN SPOUSE)
*Please complete separate application.

Where did you hear about this business opportunity?
Please be specific

What first attracted you to our company?

List 3 Character References Name/Address/Day Time Phone Number & Occupation
1
2
3

Employment during the last 5 years. List present or last job first.
Employer	Duties	Salary/mo	From - To
		$
		$
		$

How do you feel your business and/or job experience would help you run your own business?

FINANCIAL INFORMATION

Do you own your own Residence?

Yes

How long have you owned it?

Name of Bank or Banks where you have accounts: Including stocks, bonds and their value.
Name/Address	Type of Account	Current Balance

List approximate value of stocks and bonds you own

Your estimated total taxable income for the last 3 years
Year	$	Year	$	Year	$

List 3 Credit References
Name/Address	Type of Credit

Please fill in Social Security Number for each party involved.
1		2		3

Do you plan to manage your Franchise personally?

Yes

Will you have a partner in this business?

Yes

How much will partner invest?

Will this partner be active in this business?

Yes

What driving radius are you willing to service from your home?

10 or less miles

30 or less miles

more than 30 miles

Who would primarily run the business?

How flexible are your work hours?

How much capital are you in a position to invest?

State your approximate financial net worth

Additional pertinent financial information (if any)

AVAILABILITY

When will you be available to open this business?

What would be your first two choices of geographic area?
1
2

GENERAL INFORMATION

ADAPTABILITY (please be candid)	Above Average	Average	Below Average
As an organizer and a "doer" I consider myself
My ability to work independently without relying on others is, in my opinion
My ability to teach and counsel other is
I feel that my "self-starting" talents are
My level of desire to own a business is
My ability to communicate with people from all walks of life is
My patience when dealing with less qualified persons is
My thoroughness in completing any task is
My cooperation in following guidance offered is

GOALS

My annual income goal is

$25,000

$50,000

If necessary, to reach my income goal I would be willing to work a maximum of hours/per day.

PRIORITIES

Please rank the following items in order of importance to you

A. Income
B. Location
C. Independence (desire to operate own business)
D. Job Satisfaction
E. Opportunity (desire to develop an organization)

We appreciate your interest in Happy & Healthy Products, Inc. It is understood that the purpose of this application is for general information which does not obligate you or H&H in any way.

I certify that the above information supplied by me is true and correct. I authorize release of any information deemed necessary by H&H to verify any and all of the above information. I hold H&H harmless for any damages arising from verification of the information contained therein.

Happy & Healthy Products, Inc.
1600 S. Dixie Hwy., Suite 200
Boca Raton, FL 33432
Phone: 561-367-0739
Fax: 561-368-5267
behappy@happyandhealthy.com

Be Happy & Healthy� with
Happy & Healthy Products, Inc.