Hands On Science Curriculum

1) Personal Information:

Where did you hear about the High Touch High Tech - Science Made Fun Franchise?:

Internet Magazine Trade Show Other

* First Name:

* Last Name:

* Gender:

Male

Female

* Date of Birth

* Month

* Day

* Year

* Home Ownership:

Own

Rent

* Present Address:

* City:

* State/Province:

* Zip / Postal Code:

* Country:

* Citizenship:

Home Phone:

Mobile Phone:

* Email address

Marital Status:

Single Married Divorced Widowed

Military Service:

Army Navy Air Force Marines Other NA

* Have you ever been convicted of a felony or equivalent?:

Yes

No

* Has a judgment been filed against you or have you been involved in any litigation proceeding within the past 5 years?:

Yes

No

Spouse Information (Use a separate application for Partners)

* Choose a Spouse Information Option below:

Yes('Yes' Shows spouse information form fields below) No ('No' Hides spouse information form fields below)

2) Education

* Highest Education Achieved:

College Degree or Higher

Some College

High School

GED

Did not complete High School

* Name of School Attended:

* Course of Study:

* Degree Attained

3) Employment History

Upload resume or complete the Employment History form below:

* Upload Resume?

Yes

No ( * I will complete employment history form)

Current Employment Status:

* Current Employment Status:

Currently Employed Full-time

Currently Employed Part-time

Self-Employed

Unemployed

Retired

Current Employer

* Name of Current Employer

* Type of Business

* Description of Duties:

* Dates of Employment:

Previous Employment #1

Name of Previous Employer:

Type of Business

Description of Duties:

Dates of Employment:

Previous Employment #2

Name of Previous Employer:

Type of Business

Description of Duties:

Dates of Employment:

4) Financial Information

* Income from current occupation:

USD $

Income from other sources:

USD $

Describe other sources:

Assets & Liabilities

* Individual Liquid Assets
(cash, stocks, etc.):

a) USD $

* Individual Fixed Assets
(home,car, etc.):

b) USD $

* Individual Total Assets:

c) USD $ (a + b)

* Individual Liabilities:

d) USD $

* Individual Net Worth:

(c-d) USD $

* Cash available for business purposes?:

USD $

Additional Information:

* Will you be seeking a loan/financing to purchase this business?:

Yes

No

* Would this business be your sole source of income?:

Yes

No

* Have you ever filed for bankruptcy?:

Yes

No

* Do you have previous franchise experience?:

Yes

No

* Are you currently involved in a franchise?:

Yes

No

* Who will manage the daily operations of this franchise?:

* If accepted, when will you be ready to invest in a High Touch High Tech Franchise?:

5) Partners

* Will you have Partners?:

Yes

No (If no, click "Next" to Continue)

Partner #1

* First Name:

* Last Name:

* Gender:

Male

Female

* Type of Partner:

Active

Silent

* Percentage of Ownership:

%

Partner #2

First Name:

Last Name:

Gender:

Male

Female

Type of Partner:

Active

Silent

Percentage of Ownership:

%

6) Territory Location

Please list your territory preferences for opening a High Touch High Tech franchise:

* Territory / Location #1:

Territory / Location #2:

Territory / Location #3:

7) Authorization and Release

As part of the application and approval process I understand that certain background investigations may be conducted. I hereby authorize High Touch Investment Corp. to procure a Consumer Report which could include obtaining and/or verifying information regarding credit worthiness, credit standing, and credit capacity. This report may be compiled with information obtained from credit bureaus, court record repositories, past or present employers.

I authorize law enforcement and other government agencies to release to High Touch Investment Corp. any existing personal information regarding myself relative to the conviction of any criminal act.

I authorize all appropriate parties to release, or verify any information.

Disclaimer

High Touch Investment Corp will not release personal information you provide us to third parties without your written consent, absent court order or legal process.

This application form is not intended as an offer to sell or the solicitation of any offer to buy a franchise. We offer franchises solely by means of our Franchise Disclosure Document.

* I have read the the above Authorization, Release & Disclaimer.

* I consent to electronic disclosure. (If available in my country)

* Signature:

* Date:

8) Confirm and Submit

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