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Original Hippo's Financial Information Form
The submission of this form does not obligate Original Hippo's or myself in any manner.
Name
Address
City, State, Zip
Phone
Best time to call
AM
PM
Phone
Best time to call
AM
PM
FAX
E-mail
Are you a citizen of the USA?
Yes
No
Have you ever declared bankruptcy?
No
Yes
How did you become interested in an Original Hippo's franchise?
Sources of income:: Salary $
+ Bonus & Commissions = Total $
Dividends & other sources of annual income $
Amount of cash available for franchise $
Source(s)
Personal finances: Total assets $
Total Liabilities $
Will you be the sole owner of this franchise?
No
Yes
Will you be the owner-operator?
No
Yes
Do you currently own another business related to the food service?
No
Yes
Please provide the name and address of any other business(es) in which you may be involved:
Social Security Number
Drivers license
By providing this information you allow us to institute verification, or credit check. ALL OF THE ABOVE INFORMATION IS CONFIDENTIAL. Submission of this form does not constitute and offer, or intention to offer. Upon completion, please return this form with a $500 processing fee to:
ORIGINAL HIPPO'S 1648 Rochester Road, Troy, MI 48084
. (Upon purchase of a franchise, the processing fee will be refunded.)
Signature __________________________________
Date _______________
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©2004-2006 Nerd Services
12/2/06
1:23 PM
