PostalAnnex Franchise

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Franchise Application

We're very excited you're ready to talk more about owning your own PostalAnnex franchise. We look forward to speaking with you soon!

(The information you provide below will be transmitted to us via a secure connection (SSL), ensuring the privacy of your data.)

Thank you for completing this application in full.

First Name *

Last Name *

Email *

Social Security Number *

Street Address *

City *

State *

Zip Code *

Daytime Phone *

Evening Phone *

Cell Phone *

Best Time to Call *

Day

Evening

Current Occupation *

How long employed at present occupation? *

Co-Applicant's Name *

Co-Applicant's Employer *

Children *

Have you been convicted of a crime in the past 5 years? (Exclude traffic infractions) *

Yes

No

If so, please provide details

Will you or the co-applicant continue to work at your current place of employment after the franchise is awarded?

Self: *

Yes

No

Co-Applicant *

Yes

No

Who will operate the store? *

Self

Co-Applicant

Other

If other, please specify:

In what state, county and city would you like to own your own PostalAnnex+ Service Center? *

If accepted, how soon would you anticipate opening your own PostalAnnex+ Service Center? *

(Please note that answering no to the following questions does not automatically disqualify you.)

Are you a U.S. citizen? *

Yes

No

Are you a veteran of the U.S Armed Forces? *

Yes

No

FINANCIAL INFORMATION

ASSETS

Cash *

Stocks/Bonds *

Real Estate Market Value *

Automobile(s) *

Other *

LIABILITIES

Mortgage *

Auto Loan *

Notes Due Others *

Credit Card Balance *

Other *

NET WORTH

Net Worth (Total Assets - Total Liabilities) *

OTHER FUNDING

Do you anticipate obtaining a loan from another source to assist you in funding this franchise opportunity? *

Yes

No

Please note that answering yes to the following questions does not automatically disqualify you.

Loan Source

Amount

Where will the funds come from to meet the initial cash injection requirement of start-up? *

SOURCES OF INCOME

Interest *

Alimony *

Pension *

Real Estate *

Inheritance *

Other *

If "Other", please explain:

Have you ever filed for bankruptcy? *

Yes

No

This is not a franchise offering. A franchise offering can be made by us only in a state if we are first registered, excluded, exempted, or otherwise qualified to offer franchises in that state, and only if we provide you with an appropriate franchise disclosure document. Individualized responses or communications to you that involve either effecting or attempting to effect the sale of a franchise will be made only if we are first in compliance with state registration requirements, or are covered by an applicable state exclusion or exemption.

Notice of Available Disclosure Formats

If you qualify as a franchisee prospect, we will provide the electronic form of our franchise disclosure document to you in PDF format, sent by mail to the address you provide to us. You will need to have Adobe Reader software installed on your computer to open and view the PDF document. We recommend that you download or otherwise preserve a copy of the electronic franchise disclosure document. If you request it, we will furnish you with our franchise disclosure document in paper form. We will provide the paper form of our franchise disclosure document to you in person if you visit our offices, or we will mail or courier the document to you at our cost. If you are a prospect that is covered by Indiana law, we will also provide you with a paper summary of the FDD.

I agree the information contained is true, accurate, and complete to the best of my knowledge. *

Yes

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