Name *FirstLastAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of Birth *Marital StatusPhoneEmail *Desired Territory?Liquid Capital Available *85k - 100k100k - 300k300k - 500k500k - 1mCredit Score/Date Checked | If you have not checked your credit score in the last 6 months, you can obtain a free report online. *Tell us about your education *Have you ever been convicted of a felony, misdemeanor or DUI? *YesNoAre you a defendant in any lawsuit or legal action? *YesNoEmployment (We will not contact your employer without your permission) *Please tell us about your employmentYour annual income *Spouse’s Annual IncomeOther IncomeCheckboxesWould this business be your sole source of Income? *YesNoAre you able to obtain financing for the remainder and if yes how?Ever owned your own business? *YesNoWho is going to own the franchise? *Your desired territories (Please include county and zip) *If approved, when will you be ready to execute Franchise Agreement? (must provide date) *If approved, when will you be ready to open your store? (must provide date) *Please explain your plans for this business *When would be a good time for us to reach out to you?I certify that the information provided above is true and accurate, *FirstLastDigital Signature: *FirstLastSubmitting this application does not obligate the applicant to purchase a franchise or for Lume' Lash to sell a franchise to the applicant. Thank you for taking the time to fill out the application and we look forward to speaking with you soon! WebsiteSubmit