1.
debtDr
APPLICATION FORM
Welcome to debtDr.
In order to consider your potential, we require more details about you and your business experience up until the present
day.
Please do not be concerned about this. As a progressive company in the exciting field it is far more important to ascertain your
future goals, aspirations and attitude rather than dwell on what has happened in the past, It would, however, be amiss of us not
to touch on your success (or failure) up to now, so please give as much detail as possible - warts and all.!
Once we have received your completed form we will contact you within seven days to discuss your application further.
May I thank you for your interest in debtDr and this recession-proof business opportunity, and I look forward to receiving your
application form in due course. Please do not hesitate to contact me should you have any questions regarding the form.
Jeremy Hockley
Managing Director - debtDr
APPLICANTS DETAILS SPOUSE/PARTNER
Full Name (Mr/Mrs/Ms/Miss): Full Name (Mr/Mrs/Ms/Miss):
Nationality:
Address: Date of birth:
Occupation:
CHILDREN
Postcode: Names & ages:
Telephone (home):
Telephone (work):
Telephone (mobile):
email:
How long have you been at this address?: OTHER DEPENDENTS
Please give names & relationships:
Nationality:
Date of birth: Do you have a valid UK driving licence?: Yes No
Hobbies & interests: Number of points on licence:
Have you ever had a serious illness/disability?: Yes No
If yes please give details:
Marital status:

2.
APPLICANTS DETAILS 6. Describe any other relevant experience:
1. Why are you seeking a business of your own?:
7. How do you see the role of being a debtDr
2. What appeals to you about debtDr?:
8. How do you think your previous experience will help with that role?:
3. What other business formats have you looked at?:
9. Describe your expectation of the role that the head office will play in
helping you to succeed:
4. Describe any training or experience you have in sales & marketing:
10. Will you give your full-time efforts to debtDr?:
11. To what level will your partner actively support your business?:
5. Describe what experience you have in people management and motivation:
12. Which areas would you prefer to operate in?:
1st choice:
2nd choice:
Would you be prepared to relocate? Yes No
13. When would you be prepared to start your business?:

3.
FINANCIAL INFORMATION EMPLOYMENT & BUSINESS HISTORY 2
Full Name (Mr/Mrs/Ms/Miss): Employer/business name & address:
Address:
Postcode:
Postcode: From: To:
Account name:: Position/nature of business/reason for leaving:
Account number:
Sort code:
Have you ever: Leaving salary:
Been declared bankrupt? Yes No
Been a director of a company that has gone
into liquidation
Yes No EMPLOYMENT & BUSINESS HISTORY 2
Had a high or county court judgements against you? Yes No Employer/business name & address:
Been refused a bank loan? Yes No
Had any criminal convictions pending or otherwise? Yes No
If yes please give details: Postcode:
From: To:
Position/nature of business/reason for leaving:
EMPLOYMENT & BUSINESS HISTORY 1
Employer/business name & address: Leaving salary:
RESEARCH
Postcode: Which sources of information did you use when researching business
opportunities? (please tick all that apply)
From: To:
Position & nature of business: British Franchise Association (BFA)
Chamber of Commerce
Bank or Building Society
Current salary: National Newspapers
Franchise Trade Press
EMPLOYMENT & BUSINESS HISTORY 2 Franchise Exhibitions
Employer/business name & address: Franchise Website
Business Directories
Daltons Weekly
Postcode: Other (please detail below)
From: To:
Position/nature of business/reason for leaving:
Leaving salary:

4.
ADDITIONAL INFORMATION APPLICANTS DETAILS
Please use this space for any additional information to support your
Why did you decide to apply to debtDr
application:
This application form does not commit you or debtDr in any way. All information will be held in strict confidence and no
references taken without your permission.
I the undersigned am completing the above information without any obligation to enter into a debtDr licence. I also
acknowledge that any information given to me by debtDr is in complete confidence and will not be divulged by me to any
third party or used to the disadvantage of debtDr or any of its licensees.
Signed: Dated:
Please sign and return this form with a recent photograph of yourself to: debtDr, Frogmary Green Farm, South Petherton,
Somerset. TA13 5DJ. Tel: 0845 123 4000. email: support@debtDr.co.uk
HEAD OFFICE USE ONLY
ATM Yes No
AR Yes No
PTT Yes No
ATTACH
FSL Yes No PHOTOGRAPH
HERE
IS Yes No
Additional comments/action
Application Form 160109
debtDr