Date:   Mr. Mrs. Ms.
First Name:   Middle Initial:   Last Name:
City:   State:   Zip:
Home: Rent Own
Status: Single Married   Number of Dependent Children:
Your Age:   Spouse's Age:
Education: High school Some college College graduate
Three Character References (not related to you):
1) Name:   Address:
2) Name:   Address:
3) Name:   Address:

 Present Occupation:
 Annual Income: $   How long at present job?
 If self-employed: Part-time Full-time Not self-employed   Title:
 City:   State:   Zip:


 Do you plan to devote full-time to this business venture? Yes No
 Will your spouse be active in the franchise? Yes No
 Do you plan to have others active in the franchise? Yes No
   If yes, who / relationship:
 Have you previously been in a similar type of business? Yes No
   If yes, describe:
 In what area would you prefer to open your location?
   Choice 1:
   Choice 2:
   Choice 3:
 When would you like to start?
 Please briefly state why you would like to become a Franchise Owner with
 Under the Sea Indoor Playground, Inc.:

 Bank name: 
 Location:   Phone:
 Checking Savings Both
 Cash on hand and in bank (include savings account): $
 Real estate (current market value): $
 Stocks and bonds: $
 Life insurance (current cash value): $
 Personal property: $
 Other assets
 Total Assets: $
 Total Liabilities: $
 Total net worth (assets - liabilities): $
 How much capital will you invest?  $
 Will obtain capital via:
 Savings  Relatives  Home Equity  Stocks  Bank Financing  IRAs