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REQUEST TO BE CONSIDERED
AS A FRANCHISEE

Franchising
Franchising FAQ
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Request for Consideration

The information you submit on this form will allow us to better evaluate your qualifications to be awarded a Mia Za’s Café Franchise. This is not meant to be an application and should you qualify we will be requesting additional information. Please complete each and every question before attempting to proceed on to the next page. All questions must be answered before advancing.

YOUR PERSONAL DATA - SECTION A

I have read your criteria and verify by submission of this form that I am qualified for franchise consideration

Name Address City State ZIP Code Years At Address

Business Phone Mobile Phone Best Time To Call Email

Birth Date

Marital Status Single Married

Have you ever declared bankruptcy? Yes No

Have you ever been convicted of a felony? Yes No

Are you current in your taxes, both business and personal? Yes No

Were you or your business ever subject to a tax lien? Yes No

Have you ever sued or been sued? Yes No

If so, provide a summary of the suit(s) and outcome

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