Molyneaux - Batteries Plus Franchise Application

Owner Names*

Business Names*

Business Address*

Street AddressAddress Line 2CityStateZip Code

Business Phone*

Business Fax*

Business Email*

Business Type*

Date Lease Signed*

MM

DD

YYYY

Date Fit-Out-To Begin*

MM

DD

YYYY

Date of Store Opening*

MM

DD

YYYY

Renewal Date*

MM

DD

YYYY

Years In Business*

Employee Count*

Location 1

Address*

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Do you own the property?*

Are You Required to Provide Insurance?*

Estimated Annual Receipts*

Building Value*

Improvements (Fit-Out) Value*

Inventory Value*

Location 2

Address*

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Do You Own The Property?*

Are You Required To Provide Insurance?*

Estimated Annual Receipts*

Building Value*

Improvements (Fit-Out) Value*

Inventory Value*

Location 3

Address*

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Do You Own The Property?*

Are You Required To Provide Insurance?*

Estimated Annual Receipts*

Building Value*

Improvements (Fit-Out) Value*

Inventory Value*

Additional Interests

Please include lien holders, etc.

Name and Nature

Address

Street AddressAddress Line 2CityStateZip Code

Second Additional Interest

Name and Nature

Address

Street AddressAddress Line 2CityStateZip Code

Vehicles

Year

Make

Model

VIN

Leased?

Second Vehicle

Year

Make

Model

VIN

Leased?

Third Vehicle

Year

Make

Model

VIN

Leased?

Drivers

Name

FirstLast

Date of Birth

MM

DD

YYYY

DL State

DL Number

Second Driver

Name

FirstLast

Date of Birth

MM

DD

YYYY

DL State

DL Number

Third Driver

Name

FirstLast

Date of Birth

MM

DD

YYYY

DL State

DL Number

Owner and Payroll

Names of Owners and their Duties*

Owner(s) Payroll*

Store Employees Payroll*

Outside Sales Employees Payroll*

Clerical Employees Payroll*

Umbrella Limit*

Garage Keeper's Limit*

Molyneaux
Insurance

Batteries Plus Franchise Application

Batteries Plus Application

Location 1

Location 2

Location 3

Additional Interests

Second Additional Interest

Vehicles

Second Vehicle

Third Vehicle

Drivers

Second Driver

Third Driver

Owner and Payroll

Testimonials

Recent Blog Posts

Blog Topics

MolyneauxInsurance

Batteries Plus Franchise Application

Batteries Plus Application

Location 1

Location 2

Location 3

Additional Interests

Second Additional Interest

Vehicles

Second Vehicle

Third Vehicle

Drivers

Second Driver

Third Driver

Owner and Payroll

Testimonials

Recent Blog Posts

Blog Topics

Molyneaux
Insurance