Franchise Application

PART A

Location Interest:

PART B

GENERAL INFORMATION

Briefly describe any relevant business experience you may have:

PART C

Instructions: (Please attach additional pages if necessary for any question in this section)

PART D

(If Yes, please complete this section. A separate application form must be submitted for each listed partner, including consent for background and credit check prior to final approval of the franchise)

Partner 1:

Briefly describe any relevant business experience you may have:

Partner 2:

Briefly describe any relevant business experience you may have:

Partner 3:

Briefly describe any relevant business experience you may have:

PART E

Current Monthly Income:

(All financial information submitted will be held and treated as confidential)

LIABILITIES

Credit Card(s) or margin credit held and limit(s):

Which specific assets do you intend to use to meet the cash requirements?

PART F

References

*Please supply at least one financial reference.

I hereby certify that all information provided in this application is true and correct as of the date below. I authorize The AD Leaf or its affiliates, or agents and franchise team to conduct any necessary credit and background checks. I hereby waive any rights conferred upon me by the statute or otherwise regarding any disclosures obtained by The AD Leaf or its affiliates or agents. I understand that any false information or consequential omission contained in this application would be cause for immediate termination of any subsequent agreement reached between the applicant and The AD Leaf. The submission of this application does not obligate The AD LEAF or the applicant in any way or manner.