Franchise Application Form for West/South West (Galway, North Tipperary & Clare)Please Wait(if there is no response after one minute, please contact support) Page 1Page 2Page 3Page 4Page 5Page 6Page 7Page 8Page 9Application Details Title Please SelectMrMrsMsMiss Full Name(s) Surname Post Code Years at this address Owner / Tenant / with parents / other? AddressContact Phone Number Mobile Number Email Do you have a full, clean driving licence? Yes No If not, please state the number of penalty points and expiry date(s) NextPage 1Page 2Page 3Page 4Page 5Page 6Page 7Page 8Page 9Employment History Please outline your employment history, starting with your current situation. Begin Date End Date Position Salary Full Name(s) Post Code Address Delete Add Previous NextPage 1Page 2Page 3Page 4Page 5Page 6Page 7Page 8Page 9Education and QualificationsHealth Please give any details of any major illnesses in the past five years. Previous NextPage 1Page 2Page 3Page 4Page 5Page 6Page 7Page 8Page 9Would your spouse / partner be involved in the franchise? Yes NoIf so, in what capacity? Previous NextPage 1Page 2Page 3Page 4Page 5Page 6Page 7Page 8Page 9Financial Status It is important that we understand your financial situation. Please therefore provide as much information as clearly as possible.Assets Home Stocks & shares Cash savings Other (specify) Name Amount Delete Add Total Liabilities Mortgage Other Loans Credit Cards Other (specify) Name Amount Delete Add Total How do you propose to find the required capital? Previous NextPage 1Page 2Page 3Page 4Page 5Page 6Page 7Page 8Page 9Your Interest in taking on a franchise Where did you hear about Card Connection Have you looked at other businesses?What geographical areas are you interested in? 1 2 3 Are there any factors which would prevent your from giving this franchise your full-time attention? Yes No Please give detailsHave you ever operated a business of your own? Yes No Please give details What skills or experience do you have that would help you to be successful? Previous NextPage 1Page 2Page 3Page 4Page 5Page 6Page 7Page 8Page 9Other InformationHave you ever been bankrupt? Yes No Please give detailsHave you ever had a County Court Judgement entered against you? Yes No Please give details Please use the space bellow to provide any other information that your think is relevant to your application as a Card Connection franchise. Previous NextPage 1Page 2Page 3Page 4Page 5Page 6Page 7Page 8Page 9References (These will not be taken up if proceeding) Personal (NOT relatives) Telephone Bank Accountant Solicitor Previous NextPage 1Page 2Page 3Page 4Page 5Page 6Page 7Page 8Page 9Declaration I confirm that the information supplied above is accurate and true in every respect.I agree that this information will be used to help assess my suitability as a franchisee and may be disclosed to third parties e.g. credit reference agencies in order to help us verify the information and / or may need to be supplemented with additional information from me. I understand that if Card Connection discover that any of this information is incorrect or untrue, it may withdraw any offer of a franchise or terminate my appointment as a franchisee without liability.I also confirm my understanding that any information supplied to me about the Card Connection franchise or about Card Connection is confidential and shall only be used my me and my advisors for the purpose of deciding upon taking a Card Connection franchise. Submission of an application form does not oblige Card Connection to make an offer to me or oblige me to accept any offer made. We confirm that the information supplied above is accurate and true in every respect.We agree that this information will be used to help assess our suitability as a franchisee and may be disclosed to third parties e.g. credit reference agencies in order to help us verify the information and / or may need to be supplemented with additional information from us. We understand that if Card Connection discover that any of this information is incorrect or untrue, it may withdraw any offer of a franchise or terminate our appointment as a franchisee without liability.We also confirm our understanding that any information supplied to us about the Card Connection franchise or about Card Connection is confidential and shall only be used my us and our advisors for the purpose of deciding upon taking a Card Connection franchise. Submission of an application form does not oblige Card Connection to make an offer to us or oblige us to accept any offer made. Upload Applicants Signature Date Upload Spouse / Partner's Signature (if applicable) Date Previous Submit