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Prospective Franchisee Information Sheet

This is not a contract or legal document. This is an information sheet completed by a prospective franchisee who may have applied to administratively become a franchisee.
This document does not create a legal relationship and is only used to gather information should the parties later enter into a written Franchise Agreement.
This document is not an agreement nor promise, nor an approval of any type.

Please Complete Section A, Section B, and Section C.

Section A

PROSPECTIVE FRANCHISEE INDIVIDUAL NAMES AND ADDRESSES

Please identify the names of the individuals that may become Clearview Insurance franchisees. Even if you intend to establish a corporate entity (See, Section B), please identify the individuals that will own such corporate entity.

FRANCHISEE 1

Individual Name *Home Address *(Street, City, State, Zip Code)Email Address *LayoutSpouse’s Name *Spouse’s Email *

FRANCHISEE 2 (IF YOU HAVE A BUSINESS PARTNER, PLEASE FILL OUT THEIR INFORMATION BELOW)

Individual NameHome Address(Street, City, State, Zip Code)Email AddressLayout (copy)Spouse’s NameSpouse’s EmailNumber Of Units *Site Selection Area *Address If Location In Already Identified(Street, City, State, Zip Code)Location You’re Interested In Opening a [Brand Name], If Location In Not Identified(Street, City, State, Zip Code)Sales Professional / Broker *

MANAGER INFORMATION

If the individuals identified above do intend to manage the day-to-day operations of your potential
Clearview Insurance franchise and you intend to hire a manager employee that will attend initial
training, identify.

Manager / Employee Name *Home Address *Email Address *

Section B

PROSPECTIVE FRANCHISEE CORPORATE INFORMATION

Name *Corporate Entity Address *Corporate Entity Tax Identification Number *Corporate Entity State of Formation *Percentage of Ownership of Each Partner *

Section C

ATTORNEY INFORMATION

NOTE: Prior to signing any franchise agreement, Clearview Insurance
always recommends that our prospective franchisee partners hire an experienced attorney to review the Clearview Insurance Franchise Disclosure Document (“FDD”) and franchise agreement. If you have hired an attorney or intend to hire an attorney and you know his or her information, please complete the information below.

I / We do not intend to hire an attorney.

I / We have hired an attorney or intend to do so and our attorneys information is as follows.

Attorney Name *Attorney Phone Number *Attorney Email Address *

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