Spouse Name
 (If Married)    *

Other names Known by      *

Are you of legal age in your area of residence?      Yes     No  *

Have you ever been convicted of a felony?          Yes     No  *

Telephone (Home) *        (Fax)                     (Mobile)
    

Present Address       *
Mailing Address        *

City *        State/Province *      P.O.BOX No. or Postal Code * 
Country* AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOLA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN AZORES BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA-UKM BHUTAN BOLIVIA BOPHUTHATSWANA BORNEO BOSNIA BOTSWANA BRAZIL BRITISH VIRGIN ISLANDS BRITISH WEST INDIES BRUNEI BULGARIA BURINKA FASO BURMA BURUNDI BYELORUSSIA CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN, BRITISH WEST INDIES CENTRAL AFRICAN REPUBLIC CHAD CHANNEL ISLANDS, U.K. CHILE CHINA COLOMBIA COMORO ISLANDS CONGO COOK ISLANDS COSTA RICA CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC REPUBLIC OF CONGO DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGUATORIAL GUINEA EGYPT EL SALVADOR ENGLAND ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH WEST INDIES GABON GAMBIA GAZA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUATEMALA GUINEA GUINEA-BISSEAU GUYANA HAITI HONDURAS C.A. HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ ISLAND OF GOZO ISRAEL ITALY IVORY COAST JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRGHISIA KIRIBATI KOREA KUWAIT KYRGYZTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARGARITA MARIE GALANTE MARTINIQUE MAURITANIA MAURITIUS MEXICO MOLDOVA MONACO MONGOLIA MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NEPAL NETHERLAND ANTLLES NETHERLANDS NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NORTH KOREA NORTHERN IRELAND NORWAY OMAN PAKISTAN PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR RAS AL-KHAIMAH REPUBLIC OF IRELAND REPUBLIC OF SEYCHELLES REUNION ISLAND ROGAN ROMANIA RUSSIA RWANDA SAINT KITTS SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SCOTLAND SENEGAL SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOMALIA SOUTH AFRICA SOUTH KOREA SPAIN SRI LANKA ST MAARTEN 'N ND ANTILLES SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANGIERS TANZANIA THAILAND TOGO TORTOLA TRANSKEI TRINIDAD, WEST INDIES TUNISIA TURKEY TURKMENISTAN TURKS & CAICOS TUVALLU UGANDA UKRAINE UNITED ARAB EMIRATES URUGUAY USSR UZBEKISTAN VANUATU VATICAN CITY VENDA VENEZUELA VIETNAM WALES WEST AFRICA WEST BANK WEST INDIES WEST MALAYSIA WESTERN SAMOA YEMEN ARAB REPUBLIC YUGOSLAVIA ZAMBIA ZIMBABWE                                                             Email Address      *             

EDUCATIONAL BACKGROUND

                  School/College Attended  *               Years*                              Grade or Degree Attained *        
          
         
         
 

BUSINESS INFORMATION

       Self Employed   *Yes No
     Employed By  *     No. of Years 
     Address  
     City    State/Province    Postal Code
      Telephone (Business)   Position  
          (Example: 61-8-555-5555)   country & city code
          Nature of Business 
     May you be contacted at work?  Yes   No *

                                                                   

REFERENCES  (excluding relatives)

                                                                                                    (Example: 61-8-555-5555).
                 Name                                          Address                                    Telephone#(country & city code)
            
          
          

Please complete page 2
 

PERSONAL INFORMATION (Please list figures in U.S. Dollars)

Income from present occupation $ * per year.          Other Income $ *
If other income, explain   *

      Personal Bank(s) *                Branch *                              Address *                                  City *              State/Province *
           
 

SPECIFIC DATA (Please list figures in U.S. Dollars)

* Would this business be your sole source of income?  Yes No
* Own Home or Rent?  Own Rent   If Own, Current Value $   Mortgage $   
* Your Total Assets  * Your Total Liabilities $   * Your Net Worth $
* Amount of Cash Available for Investment $        * Do You Have a Financing Source? Yes  No
Amount of Financing Available $ *
If qualified, when would you be ready to invest in your Franchise?         *
                                                                                                (example: 04/30/2001)

Will you be the sole owner of this business? Yes No  *
Location Preference *

If names are to be included on the Franchise Agreements, please have these individuals fill out a separate application.

When can you start training?  *
                      (example: 04/30/2001)

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 a credit bureau or security consultant selected by Franchisor and Grano Coffee in the United Arab Emirates their officers, agents, employees and servants from any liability arising from the preparation of this report or investigation relating thereto.

I understand that any information I receive from the Franchisor or from any employee, agent, or franchisee of the Franchisor is highly confidential, ("Confidential Information"), has been developed with a great deal of effort and expense to the Franchisor, is being made available to me solely because of this application. I agree that I shall treat and maintain all Confidential Information as confidential, and I shall not, at any time, without the express written consent of the board of directors of the Franchisor, disclose, publish, or divulge any Confidential information to any person, firm, corporation or entity, or use any Confidential Information, directly or indirectly, for my own benefit or the benefit of any person, firm, corporation or other entity, other than for the benefit of Franchisor.

These terms shall be in accordance with the law of the United Arab Emirates, the courts of the United Arab Emirates and any arbitration shall be at the Chamber of Commerce in Dubai.

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 a credit bureau or security consultant selected by franchisor and Grano Coffee in the United Arab Emirates 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 photocopy or facsimile or email of this release be considered as valid as the original.

Everything that I have stated in this application is true and I understand that the information provided by me will be relied upon by the Franchisor. I read, understand, and agree to all of the above.

I understand that the granting of a Franchise is at the sole discretion of the Franchisor (Grano Coffee in the United Arab Emirates).
 

       Date  *                  Applicant's Signature (required)     *
          (example: 04/30/2001)
       Date *       Spouse's (If Married) Signature (required) *