U.S. Franchise Information Request Form

First Name *

Last Name *

Company Name

Primary Telephone *

Cell or Alternate Telephone

Email *

Confirm Email *

Permanent Address

Country *

Street Address

City

State / Province

Zip / Postal Code

Which state(s) are you interested to develop the Emerald City Smoothie brand? *

Do you or your company currently own/operate business(es) in the state(s) selected above? *

Title

Website

Describe the nature of your company's business

EXPERIENCE

Please describe the experience you have that will contribute to helping you own/operate an Emerald City Smoothie

FINANCIAL INFORMATION

Please provide the following financial information based on the most recent fiscal year (in US Dollars)

Net Worth

Liquid Cash Available

INTEREST & STRATEGY

How many Emerald City Smoothie units do you want to open? *

Why do you think Emerald City Smoothie would succeed in the proposed geographic area? *

Why are you interested in Emerald City Smoothie? How does Emerald City Smoothie fit with your strategy? *

Is there anything you would like us to know about you?

How did you hear about us? *