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Aladdin Doors Franchising, Inc. Confidential 2255 Lois Drive, Unit 6 Rolling Meadows, IL 60008 Information 888.325.2334 [email protected] Request www.AladdinDoorsFranchise.com Form

PLEASE ANSWER ALL QUESTIONS

APPLICATION DATE:

PERSONAL INFORMATION Last Name First Name Middle Name Telephone Number ( )

Birth Date (MM/DD/YY) Age Email Address

Current Address City State ZIP How long?

Previous Address City State ZIP How long?

Marital Status Name of Spouse Occupation of Spouse Number of Dependents

APPLICANT'S FRANCHISE PLANS Territory for which application made Would you consider any other area? YES NO

If yes, please explain

Will the franchise be owned and operated by you or a group?

Explain

Amount of capital available for this business

Describe

THIS IS NOT A CONTRACT AND SUPPLYING OR COMPLETING THIS FORM INCURS NO OBLIGATION ON EITHER PARTY. EDUCATION PLEASE LIST ALL EDUCATION YOU HAVE RECEIVED INCLUDING HIGH SCHOOL, COLLEGE, MILITARY OR SPECIAL TRAINING. High School Dates of Attendance Major & Minor Fields (MM/DD/YY) To Location Grade Average or Class Diploma or Date of Graduation Standing Degree (MM/DD/YY)

College Dates of Attendance Major & Minor Fields (MM/DD/YY) To Location Grade Average or Class Diploma or Date of Graduation Standing Degree (MM/DD/YY)

BUSINESS & PROFESSIONAL EXPERIENCE PLEASE PROVIDE YOUR EXPERIENCE, BEGINNING WITH YOUR PRESENT OR LAST POSITION. INCLUDE MILITARY SERVICE. INDICATE BY ASTERISK (*) THOSE EMPLOYERS YOU DO NOT WISH US TO CONTACT. Have You Ever Been in Business for Yourself? YES NO

If yes, please explain.

Name & Address Of Employer

Position, Title & Duties

Dates Of From: (MM/DD/YY) To: (MM/DD/YY) Employment

Supervisor’s Name & Title Phone Number

Reason for Separation Beginning Salary Ending Salary $ $

Reason for Separation Beginning Salary Ending Salary $ $ PHYSICAL CONDITION INCOME General Physical Date of Last Physical Condition Exam YEAR EARNED (salary, commissions, $ fees, etc.) $ List Any Physical Impairments Or Chronic INTEREST & DIVIDENDS Illnesses Which May Preclude Certain Types Of RECEIVED $ Activities RENTS RECEIVED $ $ OTHER INCOME $ $ Explain $

TOTAL GROSS INCOME

REFERENCES PLEASE LIST THREE BUSINESS REFERENCES 1. Name Addres Telephon ( ) s e 2. Name Addres Telephon ( ) s e 3. Name Addres Telephon ( ) s e

CRIMINAL BACKGROUND Have you ever been convicted of a felony? If yes, please explain YES NO

CONFIDENTIAL FINANCIAL STATEMENT DATE: YEAR: 20 PLEASE ANSWER ALL QUESTIONS OR INDICATE N/A ASSETS LIABILITIES AND NET WORTH Cash on Hand & Unrestricted in Banks) $ Notes Payable to Banks, Unsecured Direct $ Borrowings Only U.S. Government Securities $ Notes Payable to Banks, Secured Direct $ Borrowings Only Accounts & Loans Receivable $ Notes Receivable, Discounted with Banks, $ Finance Companies, etc. Notes Receivable, Discounted With $ Notes Payable to Others, Unsecured $ Banks, Finance Companies, etc. Life Insurance, Cash Surrender Value $ Notes Payable to Others, Secured $ (Do not deduct loans) Other Stocks & Bonds $ Loans Against Life Insurance $

Real Estate $ Accounts Payable $

Automobiles Registered in Own Name $ Interest Payable $

Other Assets (itemize) $ Taxes & Assessments Payable $

Mortgages Payable on Real Estate $

Other Liabilities (itemize) $

TOTAL ASSETS $ TOTAL LIABILITIES $

NET WORTH $

“I submit the foregoing information as my complete and true personal and financial condition as of the date shown below. In accordance with the Privacy Act (5 U.S.C. 552 a), Freedom of Information Act and The Fair Credit Reporting Act, I expressly authorize any past or present employer, any law enforcement agency, federal, state or local, or any person who has personal knowledge of my character, work experience or criminal records to release this information to the Franchisor. If requested by the Franchisor, I agree to supply statements from my professional advisors (i.e., banker, broker, accountant or attorney) verifying the above assets, and I also agree to furnish copies of Federal Income Tax Returns as filed for the last five years. I understand that the Franchisor is relying upon all the above information as a material factor in considering my application to become a franchisee, and I therefore agree to promptly notify the Franchisor of any material change in any of the above information or any subsequent information provided to franchisor. In addition, I release all persons from liability as a result of true, accurate information. Further, Franchisor confidential information and trade secrets will not be disclosed by Applicants to any other person or business entity, and will not be used by Applicants in any manner outside the evaluation process, either during or after the evaluation process.”

Signature Date