Tuffy

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Confidential Qualification Sheet.

Personal

Name

Age

Home Address

How long there?

City

State

Zip

Date of Birth

If Married, Spouses First Name

# of Dependents

Home Phone

Business Phone

E-mail Address

WORK HISTORY AND EXPERIENCE

Last 5 Years Work History (including present job).

Company Name and Address

Position

Avg. Annual Income

1

Name

Address

City, State, Zip

2

Name

Address

City, State, Zip

3

Name

Address

City, State, Zip

EDUCATION:

Select last year completed

High School

College

YOUR ASSETS:

YOUR LIABILITIES:

Checking Account

Personal Loans

Savings Account

Business Loans

Other Account

Home Mortgages

Home fair market value

Other Mortgages

401K / IRA

Autos

Other Real Estate - fair market value.

Other Assets

Total Assets

Total Liabilities

Are your assets in a trust?

Total Assets Minus Total Liabilities

Additional sources of income

GENERAL INFORMATION

What geographic market(s) are you interested in?

First Choice

Second Choice

Third Choice

Would you be willing to relocate or accept another location?

If yes, Where?

What prompted you to contact Tuffy?

Do you have a friend or relative that is presently affiliated with Tuffy?

If yes, indicate name

and relationship

Have you ever owned your own business?

If yes, type of business

Do you have a financial interest in other businesses?

If yes, Please explain

Are you a defendant in any legal suits or legal actions?

Have you been convicted of a crime other than a minor traffic offense?

If yes, Please explain

Have you ever taken bankruptcy?

If yes, Please explain

Is your financial position adequate to presently make the initial investment?

REFERENCES

BUSINESS

Individual

Title

Company

City

State

Phone

1

2

CHARACTER

Individual

Title

Company

City

State

Phone

1

2

I would like to be considered as a possible Tuffy^® Tire & Auto Service Center Franchisee. I understand that the signing of this application does not commit me or Tuffy Corporate in any way and that all information provided will be held in the strictest confidence. Any material misrepresentation of my financial position provided in this qualification sheet shall be adequate ground for Tuffy Corporate to rescind any agreements entered into with me in reliance upon such data. I hereby authorize Tuffy Corporate to verify through usual and customary commercial channels the information provided by me. I understand that I may request a copy of any report obtained by Tuffy Corporate in verifying my financial position. In the event of a material change in the data contained herein, I will promptly advise Tuffy Corporate of same. If I am accepted as a Tuffy Corporate Franchisee, I authorize Tuffy Corporate to disclose this and any credit information which may be obtained by Tuffy Corporate Upon approval for franchise interview, Tuffy Corporate will require that all applicants file a detailed financial statement.