Personal Information First Name* Last Name* Email* Address City State Contact No. Professional Information Present Job/Business Ever owned a business?YesNo If Yes, what type of business Ever been a franchise of other concept? YesNo If Yes, please describe the type of other business Location Information City* Location preference* Own an existing commercial space? YesNo If yes, describe the location details (like corner shop or main road face, etc) If Yes, please describe the type of other business Retail Space area Demographics of the location I certify that the information for Hazel franchise request that I have provided is true and correct. I authorize Hazel to verify the information I have provided on this request.