New York Burger Co

BTS Franchises LLC

APPLICATION FOR A FRANCHISE

Thank you for your interest in BTS Franchises LLC. Information provided in this application is confidential and will be disclosed only for purposes of verifying its accuracy. This application is not a contract and does not obligate either party in any manner.

Please complete this application and return it to our address:

BTS Franchises LLC

612 Corporate Way

Valley Cottage, New York 10989

Telephone: 845-268-4000

Email:

For Internal Use Only (Not For Applicant):

Name of Applicant:

Date of Application:

Application Reference Number:

BTS FRANCHISES LLC

APPLICATION FOR A FRANCHISE

Personal Information

Name

Residence

City State/ZipCode

Home PhoneBusiness Phone

May we contact you at your business phone?

E-Mail Address

Social Security Number Date of Birth

Spouse’s Name

Spouse’s Social Security NumberSpouse’s Date ofBirth

Names and Ages of Children

Education

Last Year of School Completed

Name of College and/or PostgraduateSchool

Degree

Name of College and/or PostgraduateSchool

Degree

Business Experience (List most recent first)

Present Occupation Position

Company Dates Employed

Address

Describe Duties, Number of Employees Supervised and Responsibilities:

Occupation Position

Company Dates Employed

Address

Describe Duties, Number of Employees Supervised and Responsibilities:

Occupation Position

Company Dates Employed

Address

Describe Duties, Number of Employees Supervised and Responsibilities:

Do you have previous trampoline or sports experience? If so, explain

Have you ever owned or currently own your own business or franchise? If so, explain

Have you ever had a business failure? If so, explain

Describe any training in sales, management or retailing:

Financial Information

Income from Current Occupation (Salary, Wages, Bonuses, Commissions)

Income from Other sources(Dividends, Trusts, Interest)

Please Explain Other Income

Value of Individual Liquid Assets (Cash, Stocks, etc.)

Explain Liquid Assets

*Please note that we require proof (bank or brokerage statements) of a minimum of $900,000 in liquid assets in order to be considered as a qualified prospective Bounce! franchisee.

Value of Individual Fixed Assets (Real Estate, Car, etc.)

Explain Fixed Assets

Value of Other Assets

Explain Other Assets

Personal Bank Branch

Address

Personal Bank Branch

Address

Would this business be your sole source of income? □Yes □No

Explain:
Is there other financing not included above?□Yes □No

Explain:

If yes, how much financing is available?

Explain:

Are you able to make an investment decision to enter the development process in the next 60-90 days? □Yes □No

Business Information

Name and Address of Business

Description of Business

Type(Partnership, Corporation, LLC, Other)

Name of Owners

Any Relation to Applicant

Percent EquityNet Value of Your Interest

Name and Address of Business

Description of Business

Type(Partnership, Corporation, LLC, Other)

Name of Owners

Any Relation to Applicant

Percent EquityNet Value of Your Interest

How many units do you initially want to develop?

Do you own specific property that you want to develop?

Personal and Professional References

Please provide three personal and/or professional references (Name, Address and Telephone)

Geographic Preferences

Please list at least one Geographic Area where you would like to operate a Bounce Trampoline Sports!® franchise:

City State

1.______

2. ______

3.______

Operating Structure

Do you plan to operate the business yourself or if will you have operating partners or operating members if you are a limited liability company?

If you plan on having operating partners/members please complete all relevant sections below. All partners/members should fill out a separate Application. Your application will not be reviewed unless BTS Franchises LLChas received a filled out Application from each of your partners/members.

Name% OwnershipActive/SilentMale/ Female

Miscellaneous Information

Have you ever been convicted of anything other than minor traffic violations? Has any judgment ever been entered against you or your company or your employer where you were one of the litigants? Are you involved in pending litigation? If yes, explain

Have you or your spouse ever declared personal bankruptcy? If yes, explain.

Of which country are you a citizen?

Are you of legal age in your State/Province/Residence Area?

How did you hear about Bounce Trampoline Sports!®franchising opportunities?

□Bounce Trampoline Sports!®Website □Employee
□Newspaper □Franchise Referral
□Trade Publication □Lender
□Trade Show □Other:

I submit the following information as my complete and true personal and financial condition as of the date shown below. In accordance with the Privacy Act (5 U.S.C. 552 a), Freedom of Information Act and The Fair credit Reporting Act, I expressly authorize any past or present employer, any law enforcement agency, federal, state or local, or any person who has personal knowledge of my character, work experience or criminal records to release this information to BTS Franchises LLC. I understand and acknowledge that, as a part of BTS Franchises LLC’s review of my application, BTS Franchises LLCwill obtain a credit history report to be performed by a credit reporting agency of BTS Franchises LLC’s choice. I understand that the credit reporting agency will make the results of the credit history check available to BTS Franchises LLC and that BTS Franchises LLCmay use those results in determining whether I may qualify as a potential Bounce Trampoline Sports!®franchisee. If requested by BTS Franchises LLC, I agree to supply statements from my professional advisors (i.e., banker, broker, accountant or attorney) verifying my assets, and I also agree to furnish copies of Federal Income Tax Returns as filed for the last five years. I understand that BTS Franchises LLCis relying upon all the above information as a material factor in considering my application to become a Bounce Trampoline Sports!® franchisee, and I therefore agree to promptly notify BTS Franchises LLCof any material change in any of the information or any subsequent information provided to BTS Franchises LLC as part of my application. In addition, I release all persons from liability as a result of true, accurate information. I also certify that neither I nor any of my funding sources, is or has ever been a terrorist or suspected terrorist, or a person or entity described in Section 1 of U.S. Executive Order 13224, issued September 23, 2001, as such persons and entities are further described at the Internet website I agree to comply with and/or to assist BTS Franchises LLCto the fullest extent possible in BTS Franchises LLCefforts to comply with the above law.

Signature of ApplicantDate