Personal Information

• First Name
• Last Name
• Company Name
• Street Address 1
• Street Address 2
• City
• State
• Zip
• Email
• Cell Phone
• Home Phone
• Work Phone
• Fax

Business Information

• Commencement Date
• Ending Date (if seasonal)
• • Kiosk
  • In-line Leasing
  • Retail Merchandising Unit (RMU)

Concept/Product Information
Who is your target customer?

• Male
• Female
• Male and Female
• Select Target Customer Age GroupUnder 1818 - 2425 - 3435 - 4445 - 54Over 55
• Select Target Customer Income LevelUnder $15,000$15,000-$24,999$25,000-$34,999$35,000-$49,000$50,000-$74,999$75,000-$99,999$100,000 or more
• What will be your average price point?

What sales volume would you project for your concept?

• Monthly Projected Sales
• Yearly Projected Sales

Is your merchandise …

• Hand-crafted by yourself
• Wholesaled
• Franchised
• Please Describe in detail
• Attach image of product or RMU

Do you have established resources/suppliers for the product you will sell?

• Yes
• No

How long does it take to receive or produce your product?

• Overnight
• One Week
• Two Weeks
• One Month
• More than one month

Have you operated any other businesses?

• Yes
• No

Have you operated businesses in any other mall before?

• Location No. 1
• • Permanent
  • Temporary/Seasonal
• Dates
• Sales

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• Location No. 2
• • Permanent
  • Temporary/Seasonal
• Dates
• Sales

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• Location No. 3
• • Permanent
  • Temporary/Seasonal
• Dates
• Sales

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• What is five plus one?