PRINT AND FAX FREE TO: 1300 880 931 (Australia)
Post to : MPC PO Box 661 Rockingham City Western Australia 6168
E Mail : franchise@minipancake.com
Franchise Application and Questionnaire
Strictly Private and Confidential
It is a formal application to be considered for a MPC franchise. It is
neither a contract nor is it binding on the applicant or MPC, but it is an
indication that both parties are serious about entering into discussion with one
another.
The information requested in this form includes personal and financial
information that we consider crucial for you and us to make judgements about
your likely success as a MPC franchisee. We ask you to be as accurate
as possible in furnishing this information.
Name of Applicant:
_________________________________________________________
Address:
_________________________________________________________
Office use:
____/____ ___/___/___ ___________________________
Page 2
PERSONAL DETAILS
Name: ___________________________________ ______________________ __
_____________________
Surname First Names Given Names
Address: ____________________________________________________________________________________
City: _________________________State:________ Post Code: ________
Phone: (ah) ________________________ Phone (Work) ________________________
Email: ________________________________________________
How long have you lived at this address? _________________
Previous addresses, including dates:
1. _______________________________________________________________________________________________
2. _______________________________________________________________________________________________
3. _______________________________________________________________________________________________
Age last birthday: __________ Date of birth: _______________
Health:Give a brief description of your state of health, mentioning disabilities or chronic conditions that could affect your performance in a retail situation.
Are you, or have you ever been declared bankrupt? ______________
Marital status: ________________
Spouse or partner’s name: ____________________________________ Partner’s age last birthday: __________
Number of children: __________ Age of children: __________________________
Will your spouse, partner or other members of the family work in the shop with you? _____________
EDUCATION DETAILS
Please list formal qualifications such as diplomas or certificates, as well as short courses and on the job training courses that you think relevant to this application.
1. _______________________________________________________________________
Date:_________________
2. _______________________________________________________________________
Date:_________________
Page 3
EMPLOYMENT OR PROFESSIONAL DETAILS
(Please list details of your previous employment or businesses you have been involved in. List the most recent first.)
1. Dates: __________________________________________________________________________
Company: _______________________________________________________________________
Address: _______________________________________________________________________
Type of business: _______________________________________________________________
Description of your role with the business:
________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
2. Dates: __________________________________________________________________________
Company: _______________________________________________________________________
Address: _______________________________________________________________________
Type Of Business: _______________________________________________________________
Description of your role with the business: ________________ _______________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
3. Dates: __________________________________________________________________________
Company: _______________________________________________________________________
Address: _______________________________________________________________________
Type of business: _______________________________________________________________
Description of your role with the business: ________________ _
______________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Page 4
YOUR BUSINESS PLAN
Although it is too early to have a detailed business plan, it is appropriate to start to think about the
information that you will need to construct one. These questions are for that purpose:
1. Will you operate as a sole trader, in partnership or as a limited liability company?
Name of entity? _________________________________________ ACN _____________________
2. Will you devote your full time to the business? ____________________
How many hours per week? ____________________________________________
3. How will you finance your investment in MPC ?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
4. What gross income are you hoping to make:
In the first year $_____________
In the second year $_____________
In subsequent years $_____________
5. What is the minimum income you require to live on in the first year?
$_____________
Current income statement
Salary and/ or wages (applicant) .. .. $_______________________
Salary and/ or wages (spouse/partner) .. .. $_______________________
Other ________________ .. .. $_______________________
Other ________________ .. .. $_______________________
Other ________________ .. .. $_______________________
Other ________________ .. .. $_______________________
Total $_______________________
What proportion of capital required do you propose to find through borrowing? (Keep in mind that
MPC requires you to have at least 1/3 unencumbered equity in the total purchase price.)
_________________________________________________________
Over what period do you expect to repay such a loan?
_________________________________________________________
Page 5
6. FINANCIAL STATEMENT.
I. ASSETS $
Cash/ Savings _______________________
Surrender value of Superannuation _______________________
or Life Insurance policies.
Securities, bonds, debentures _______________________
Shares _______________________
Property - personal dwelling _______________________
Property - investments _______________________
Motor Vehicle(s) _______________________
Other _________________ _______________________
Other _________________ _______________________
Total Assets _______________________
ii. LIABILITIES
Home Mortgage _______________________
Other Mortgages _______________________
Personal Loans _______________________
Leases _______________________
Other _________________ _______________________
Other _________________ _______________________
Other _________________ _______________________
Total Liabilities _______________________
=============================================================
iii. NET ASSETS/ LIABILITIES.
Total Assets _______________________
Less Total Liabilities _______________________
Net Assets/ Liabilities _______________________
Page 6
GENERAL INFORMATION
1. Name and Address of your Accountant:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
2. Name and Address of your Solicitor:
_____________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________________________
3. Credit References:
i. _______________________________________ Phone: _____________
ii._______________________________________ Phone: _____________
4. Personal and Professional References:
i. _______________________________________ Phone: _____________
ii._______________________________________ Phone: _____________
Written references may be attached separately to this application form.
DECLARATION
I declare the information contained in this application form to be true to the best of my knowledge.
I understand that the information provided in this application form will be used by MPC to assess my suitability as a Franchisee.
Signature (Applicant)
__________________________________________________________
Date: _____________
Signature (Spouse/Partner)
_______________________________________________________
Date: ______________