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MASTER TERRITORY QUESTIONNAIRE If you wish to be considered for a Teddy MountainÂŽ Master License Agreement, please complete all the information requested on this questionnaire, sign the last page and either fax or scan and then email it to us. Completion of this questionnaire does not obligate you or TEDDY MOUNTAIN PTE. LTD., in any way. I. PERSONAL DATA - If you plan to have partner(s) other than your spouse, please complete a separate questionnaire for each partner Your Name: ______________________________________________________ National/Personal Insurance Number: __________________________________ Date of Birth: __________________ Email: _____________________________ Address: _________________________________________________________ (city)

(street)

(province/state)

(postal code)

Home Phone: _____________________ Work Phone: ____________________ Mobile Phone: _____________________ Facsimile: _______________________ Spouse’s Name: ___________________ Number of Children: ________________ Ages: __________________________

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TEDDY MOUNTAIN PTE. LTD.

II. FINANCIAL INFORMATIONยน - Present current financial data (or attach current financial statement) ASSETS Description Cash (Checking & Savings Accts) Marketable Securities Accounts, Notes Receivable Retirement Investment/Plans Value of Pension & Profit Sharing Real Estate (Market Value) Business Ownership Vehicles Insurance Cash Value Other Assets (Itemize)

Value ($)

Total Assets

LIABILITIES Description Vehicle Loans Real Estate Mortgage(s) Credit Card Balances Accounts Payable Taxes Payable Life Insurance Policy Loans Other Liabilities (Itemize)

Value ($)

Total Liabilities

NET WORTH (Assets-Liabilities): $_____________________ INCOME Description Salary Bonuses and Commissions Business, Professional Income Other Income

Total Annual Income

1

EXPENSES Value ($)

Description

Total Annual Expenses

TEDDY MOUNTAIN PTE. LTD., may require verification prior to awarding a License.

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Value ($)


TEDDY MOUNTAIN PTE. LTD.

Do you want to open Teddy Mountain Stores or Kiosks? _________________________________________________________________ When do you want to open your first location? (month, year) _________________________________________________________________ Cash available for investment in this business? _________________________________________________________________ Do you plan to have investors? If so, to what extent? _________________________________________________________________ Have you ever been involved in a personal or business bankruptcy? _________________________________________________________________ Do you operate any other business at this time? _________________________________________________________________

III. BUSINESS EXPERIENCE - *If available, please attach current resumes for you and your spouse with at least three references

Current Employer: Address: City, State, Zip: Position/Title: Present Salary: Date Started: Description of Work:

Self: __________________ __________________ __________________ __________________ __________________ __________________ __________________

Spouse: ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________

Previous Business Experience (list in order, most recent first): Employer:

Address:

Years/Months:

Position:

_____________ ___________________ _____________ _______________ _____________ ___________________ _____________ _______________ _____________ ___________________ _____________ _______________ _____________ ___________________ _____________ _______________

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TEDDY MOUNTAIN PTE. LTD.

IV. TEDDY MOUNTAIN – TERRITORY PLANS In what geographic area are you interested in operating as our Master? 1st Choice: ________________________________________________________ (geographic state/province or country)

2nd Choice: ________________________________________________________ (geographic state/province or country)

3rd Choice: ________________________________________________________ (geographic state/province or country)

Are you interested in owning multiple Teddy MountainÂŽ territories? _________________________________________________________________ Do you own/operate Teddy Bear retail stuffing stores today? _________________________________________________________________ If yes, how many retail stores do you operate? _________________________________________________________________ What are your average annual Cost of Goods, (orders placed at wholesale), per year, for your stores? _________________________________________________________________ Approximately how many other stores (competitors) operate in your state/country? _________________________________________________________________ Approximately how many customers (stuffing store retail customers) do you feel you can supply/distribute products to in your territory? _________________________________________________________________ What are the estimated wholesale order estimates from these customers? (approximate/best guess) Provide a dollar estimate _________________________________________________________________

Do you intend to have any active partners (other than your spouse)? _________________________________________________________________

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What Companies do you presently use as a supplier of products? _________________________________________________________________ How did you hear about Teddy Mountain速? _________________________________________________________________ What are your primary reasons for owning your own business? 1) __________________________________________________________ 2) __________________________________________________________ 3) __________________________________________________________ 4) __________________________________________________________ 5) __________________________________________________________ I certify that, to the best of my knowledge, the information contained herein is accurate and complete. TEDDY MOUNTAIN PTE. LTD., is hereby authorized to investigate my background as it pertains to qualification and status. This may include investigations of past employment, references, education and information contained in public records including credit, criminal and motor vehicle data. I release all such persons and sources from any liability or damages from having furnished such information.

Signature of Applicant: _____________________

Date: ________________

Please print, fill out, scan, attach, and email your completed questionnaire to: info@teddymountain.com -

OR

-

Please fill out and Fax your completed questionnaire to: Fax: 1 (877) 470-2327

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Teddy Mountain - Master Questionnaire (Europe)  
Teddy Mountain - Master Questionnaire (Europe)  
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