I. Personal Information Surname: Given name(s): Date of birth: Social insurance number: Home phone number: Best time to call: ( )

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1 Crepeworks Canada Inc West Edmonton Mall Street Edmonton, Alberta T5T 3J7 In order that we might help you decide if a Crepeworks franchise is right for you, please provide the following information. All information will be held in strictest confidence. Completion of this Evaluation Application does not obligate you or Crepeworks Canada Inc. in any way. I. Personal Information Surname: Given name(s): Date of birth: Address - include postal code: Since: Social insurance number: Home phone number: Best time to call: Cellular phone number: Facsimile number: Personal address: Business address: Drivers License: Place of Issue: Health: Good Fair Poor Maritial Status: If married, will spouse be active in the business? Name of spouse: Spouse's address - include postal code: Number of dependents: Since: Spouse's Social insurance number: Home phone number: Best time to call: Spouse's Personal address: Business address: Spouse's drivers license: Place of Issue: Health: Good Fair Poor

2 II. Financial Information Assets Amount Liabilities Amount Cash Notes payable to banks Securities Notes payable to others Life insurance Real estate loans Accounts / Notes receivable Accounts payable/ Sales Contracts Real estate Income tax unpaid - current year Vehicles Income tax unpaid - prior year(s) Other Assets Real estate taxes unpaid Other liabilities Total Liabilities Net Worth Total Total Gross Annual Income Salary/Wages/Commissions Dividends and Interest Rental income Business/Professional income Spouse's annual income Other income (specify) Total Gross Income Annual Expenditures Property taxes and assessments Real estate loan payments or rent Income taxes Payments on loans Insurance premiums Estimated living expenses Other (specify) Total Expenditures Net Disposable Income I understand that it is my responsibility to obtain any financing necessary to open my Crepeworks franchise. How would your franchise investment be financed? Please estimate the amount of unencumbered cash available to invest into a Crepeworks franchise: $ ( Minimum $100,000 cash required)

3 III. Banking Information Please list the names of banks or finance companies which carry your accounts or which the credit information can be obtained or verified from. Name of bank 1: Highest extended credit: $ Purpose of credit: Name of bank 2: Highest extended credit: $ Purpose of credit: Name of bank 3: Highest extended credit: $ Purpose of credit: Accountant: Name: Contact: address: Telephone No: Financial Advisor (Bank): Name: Contact: address: Telephone No: Lawyer/Solicitor: Name: Contact: address: Telephone No:

4 IV. Employment History (List Most Recent First) Business name: Position: Annual income: Dates: Business name: Position: Annual income: Dates: Business name: Position: Annual income: Dates: List business/personal references: Name: Relationship: Telephone Number: Name: Relationship: Telephone Number: Name: Relationship: Telephone Number: Have you ever owned or worked in a food service operation? If yes, where? Have you ever been convicted of a crime, other than a traffic violation? If yes, explain. Have you ever failed in business or compromised with creditors? If yes, explain. Provide details of existing or past business interests (if applicable): Trading name: Nature of the business: Trading address: Owners: Interest: % Date of commencement: Date sold or interest ceased:

5 V. Management Information How did you become interested in a Crepeworks franchise? Why do you feel you would be successful operating a Crepeworks franchise? What past experiences have contributed most to your personal development? What are your main weaknesses? Will you dedicate your full time to the business? If yes, how many hours per day, days per week will you devote your time? If no, how do you propose to operate the business? Do you have the capacity to direct, supervise and handle business, staff, and staff problems when they arise? Do you have the support of your family with purchasing Crepeworks Franchise? Are members of your family going to be involved with the business?

6 If family are going to be involved, please provide details: Are you proposing to have other partners involved in your franchise? Will he/she be active? Please explain fully: List geographic areas desired in order of preference: If your application is approved when would you want to open? Have you ever owned or worked in a similar franchise business? If yes, please provide details (name, address, telephone): Do you know what a Franchise is? Explain: To you, what would be an optimal Franchisee/Franchisor relationship?

7 DECLARATION To Crepeworks Canada Inc. 1. I acknowledge and agree that Crepeworks Canada is collecting the information contained in this Application to assess whether I/we should be considered as a potential franchisee. 2. I certify the above statement of my property and debts is true and correct in all respects. 3. I acknowledge that if any information in this Application is false or misleading in any way Crepeworks Canada shall have the right to terminate any agreement entered into on the basis of the information contained in this Application. 4. I declare that neither my spouse nor any other person has any claim in or to the assets shown above except as set out therein. The whole of my property is shown at a fair valuation. 5. Crepeworks is authorized to contact any appropriate third parties to verify the accuracy of the information in this Application and retain any information for its records; provide the information in this Application to its accountants, lawyers and consultants. 6. The acceptance of this Franchise Application by Crepeworks Canada should not be considered as a grant of a franchise. It is expressly understood that this document is not binding on either party and is intended only to assist in the evaluation of my personal and financial qualifications. 7. I understand that additional information may be required of me. 8. I understand that my signature constitutes my approval for Crepeworks Canada to conduct a routine credit and/or background investigation and I release all parties from all liability for any damage that may result from furnishing this information. 9. I acknowledge that I have read and understand this disclaimer. Print Name Date: Signature of Applicant