Request Application Fields marked with “*” are required. Personal Information *First Name: *Last Name: Phone: Email: Address Information Address: City: State/Province: Country: Zip: Background Information Date of Birth: Format: MM/DD/YYYY Education Level: Are You Married? --None--YesNo Do You Have Children? --None--YesNo Are You a U.S. Citizen? --None--YesNo Have you been Convicted of a Felony? --None--YesNo Have you Ever Filed for Bankruptcy? --None--YesNo Do You own or rent your home? --None--RentOwn Employment Information What is your current employer/position? How long in your current position? Have you ever owned a business? --None--YesNo What is your current annual income? Franchising Information *First Location Preference Second Location Preference Third Location Preference Why would you like to become A Painting Fiesta Franchisee? How did you hear about A Painting Fiesta? Would you operate the studio?: *What is your approximate net worth?: --None--Less than $150,000$150,000 - $500,000$500,000 or more *How much liquid capital are you able to invest?: $ Cash, stocks & equities - funds that are convertible and accessible today *Do you currently have a source of financing?: --None--YesNo *I authorize A Painting Fiesta to make inquiries as necessary to determine the accuracy of statements made and determine my creditworthiness. I certify the above and the statements contained are true as of the stated date.