FRANCHISEE PRELIMINARY QUESTIONNAIRE

The following information is necessary to evaluate your qualifications and interests regarding our franchise. Should you qualify and a mutual interest develops, additional information may be requested. All information provided is kept confidential and will not be disclosed except for purposes of verification. This form needs to be completed before receiving the FDD. The submission of this form places no obligation on either the candidate or Paciugo Franchising LP. If more than one candidate will be involved, please attach a separate completed form for each additional party. Please complete in as detailed manner as possible. We make the FDD available to prospective franchisees electronically in PDF format sent via e-mail. In order to access, view, download, print or otherwise maintain the FDD for future reference you will need a computer with e-mail access, Adobe Reader or Adobe Acrobat Software and a printer connected to your computer. If you prefer, you can also receive a copy of the FDD in paper format.

Please email the completed form to franchising@paciugo.com or fax it to 214-654-9509

GENERAL
Full Name Residence Address City Th residence The id is i For how long? Best way to contact Best time to contact How did you learn about Paciugo? Owned O d R Rented t d year(s) C Cell ll Home Fax Email State Zip

PERSONAL
Social Security US Citizen? Yes No If not an US Citizen, Country of Citizenship is Have you previously served in the United States Military? Marital Status Yes No Number of Dependents Driver's License Date of Birth State

SPOUSE (if any)

Full Name Occupation Social Security US Citizen? Yes No If not an US Citizen, Country of Citizenship is Driver's License Date of Birth State

EDUCATION
School/College 1 Major School/College 2 Major Degree Degree Graduated Graduated

REFERENCES (please exclude relatives)

Full Name 1 Relationship Full Name 2 Relationship Full Name 3 Relationship Phone Phone Phone

PRESENT OCCUPATION
Company Name Address City Company Industry Title Annual Income Duties/Responsibilities (please describe in detail) Date Started State Phone Number of Employees Supervised Zip

PREVIOUS OCCUPATION (please list chronologically, more recent on top)

Company Name 1 Address City Title Supervisor Name Annual Income Duties/Responsibilities State Number of Employees Supervised Supervisor Phone Date Started Date Ended Zip Phone

Reason for Leaving

Company Name 2 Address City Title Supervisor Name Annual Income Duties/Responsibilities State

Phone Zip

Number of Employees Supervised Supervisor Phone Date Started Date Ended

Reason for Leaving

Company Name 3 Address City Title Supervisor Name Annual Income Duties/Responsibilities State

Phone Zip

Number of Employees Supervised Supervisor Phone Date Started Date Ended

Reason for Leaving

LEGAL
Have you or your business entities ever filed bankruptcy? Have you or your business entities ever been a legal defendant in any lawsuits? Have you or your business entities ever been a legal plaintiff in any lawsuits? Have you ever been convicted of any crime? Yes Yes Yes Yes No No No No

FINANCIAL
Will the franchise be your sole source of income? Desired franchise business net income & realistic goals: Yes 1 year No 3 years

Estimated minimum income required for your current living expenses: When do you expect to make enough income to support your current lifestyle? Total unencumbered liquid capital readily available for use in the franchise business: What is the source of this unencumbered liquid capital? What is the amount of loan would you need? What is the type of loan would you need? Do you plan to borrow against your home? If yes, how much equity will you borrow against? Yes No

FINANCIAL STATEMENTS INCOME STATEMENT

For 12 Month Period Ending

Salary Bonuses/Commissions Dividends/Interests Real Estate Income Other Income (specify below)

TOTAL INCOME

BALANCE SHEET
Numbers Current As Of

ASSETS Cash Savings Vested Profit Sharing or 401K, etc Accounts Receivables Stocks & Bonds Real Estate (mkt value) Automobiles Personal Property Businesses Other Assets

LIABILITIES Notes Payable to Banks Notes Payable bl to Others h Credit Card Debts Real Estate Mortgages Automobile Loans School Loans Other Liabilities

TOTAL ASSETS

TOTAL LIABILITIES

NET WORTH

BUSINESS
Preferred Franchise Territories 1. City 2. City 3. City What is the desired opening date for your franchise business? Do you have a business partner to take part in the franchise? If yes, your relationship with your business partner is If yes, what will be the responsibilities of each partner? State State State

How long have you been searching for a franchise to buy? What other franchises have you researched? What is it specifically that makes Paciugo franchise more appealing to you than other franchises?

Why do you feel that you would be successful in operating a Paciugo franchise?

BUSINESS (continued)
What businesses or franchises have you ever owned?

Please list your top 3 business skills. 1. 2. 3. How many hours per week will you be working in your Paciugo franchise? Is your schedule flexible enough to work nights and weekends? On a scale of 1 to 10, with 10 being the greatest: How do you rate your ability to follow an established operating system? How do you rate your willingness to follow an established operating system? How do you rate your level of interest in owning a Paciugo franchise? When will you be able to meet? What questions would you like answered during the meeting? Yes No

I hereby certify that the information supplied on this Franchisee Preliminary Questionnaire and other financial statements made by me are true and correct. I agree to have all information confirmed by Paciugo Franchising LP, and I authorize Paciugo Franchising LP to conduct such additional credit checks as it deems necessary. I further understand that submission of this information does not obligate me to purchase a Paciugo Franchising LP or to sell a Paciugo franchise.

Date

Applicant's Signature
(print name)

This information is not intended as an offer to sell, or the solicitation of an offer to buy, a franchise. It is for informational purposes only. We offer franchises solely by means of our Franchise Disclosure Document and no franchise will be sold unless the required Franchise Offering Circular has been delivered to the prospective franchisee prior to the sale in compliance with applicable law. Additionally, any offer to sell a franchise will only be made after individuals have completed an application and been qualified to purchase a franchise. Currently, certain states, provinces, and countries regulate the offer and sale of franchises including but not limited to the following: California, Hawaii, Illinois, Indiana, Maryland, Michigan, Minnesota, New York, North Dakota, Oregon, Rhode Island, South Dakota, Virginia, Washington, Wisconsin, Alberta, Ontario, Prince Edward Island, Australia, Brazil, China, France, Indonesia, Japan, Malaysia, Italy, Mexico, Romania, Russia, South Korea, Spain, and Venezuela. If you are a resident of one of these states, provinces, or countries, we will not offer you a franchise unless and until we have complied with applicable pre-sale registration and disclosure requirements in your jurisdiction. Please contact us to learn our registration status in your state, province or country