We are located throughout California and new stores are planned. Please fill in the form below and you will be contacted soon. This form is secured with SSL 3.0, RC4 with 128 bit encryption (High); RSA with 1024 bit exchange. Right click your mouse on this page and go to properties to verify.
Important! We will not respond to an incomplete application! Personal Information
Business and Experience
Current Employment
*Current Employer Name:
*Type of Business:
Current Annual Salary:
*Employment Address
*Phone
*How Long
May we contact you at work?
*Title and description of your current duties and responsbilities and number of employees you supervise, if any, and dates employed:
*Previous Employers for the last ten years. (Include Previous Employers' names, address, and types of business, name of your supervisors, title and description of your duties and responsibilities, number of employees you supervise, if any, and your reason for leaving. Also describe any self_employment.)
*Do you now, or have you ever owned or managed, or had an interest in a business, restaurant or store? If yes, please describe:
Spouse Information
*Spouse's Name:
Age:
Spouse's Residence Address
*Phone
How Long
*Spouse's Employer Name:
*Type of Business:
Current Annual Salary:
*Spouse's Employer Address
*Phone
*How Long
Education
Name & Location of School
*Grammar School:
*Years Attended:
Did you Graduate?
*Subjects Studied:
*High School:
*Years Attended:
Did you Graduate?
Subjects Studied:
*College:
*Years Attended:
Did you Graduate?
*Subjects Studied:
*Trade, Business or Correspondence School:
*Years Attended:
Did you Graduate?
*Subjects Studied:
Monthly Income
*Salary, wages:
*Bonus, comissions:
*Dividends, interest:
*Real estate income:
*Notes / accounts receivable:
*Other income - specify source
*Total Montly Income:
Assets and Liabilities
*Asset
Value
*Cash on hand and in banks.
Account no:
Bank name
*Bank Address
*Notes, accounts and mortgages receivable:
*Real estate _ current market value:
*Net value of business interest:
*Automobiles make, model, year and value
*Other personal property, etc:
*Total Assets:
Liabilities
Amount
*Notes/loan payable to banks:
*Notes/loan payable to friends, relatives:
*Credit card debt:
*Real estate mortgages:
*Automobile debt:
*Store Accounts:
*Other debts and obligations:
*Total Liabilities:
*Total Assets:
*NET WORTH:
Important! We will not respond to an incomplete application!
