Confidential Online Questionnaire

Please have your information ready before filling out the online form.

Click here to download a printable version

* Indicates required information

*Email Address:
*Home Address:
State: Zip:
*Home Phone:
*Cell Phone:
*Work Phone:
*Date of Birth: (MM/DD/YY)
*Marital Status:
Spouse's Name:
*Will you have other ownsers/partners:
  Partner's names:


*Are you:
Name of your company or employer:
Type of business:


*Do you have $50,000 or more in liquid assets available?
*Do you have $300,000 or more net worth?
*Is your credit score 700 or above?


Has any applicant ever filed for bankruptcy protection?
Please explain:

Has any applicant ever been convicted of a felony?
Please explain:

Has any applicant ever had any suits, liens or judgments filed against them?
Please explain:

Are you or anyone in your immediate family employed by a food industry chain?
If yes, list name of employer and family relationship:


*What area of the country are you interested in?

Are you a U.S. Citizen?
If no, what country are you a citizen of?

Do you have enough income to maintain your current lifestyle without spending funds allocated for development of your Roly Poly franchise(s)?


I UNDERSTAND THAT THE ACCEPTANCE OF THIS Franchise Application by Roly Poly Franchise Systems, LLC or any of it's affiliates (collectively "Roly Poly") does not constitute the grant of a franchise. I understand that Roly Poly grants franchises only by executing written franchise agreements. By signing below, I authorize Roly Poly and its assigns to start an Investigative consumer report (including information regarding my character, general reputation, personal characteristics and mod of living) and credit investigation based on the information voluntarily provided by me and warrant that all information provided is true and accurate. I understand that I have a right to request that Roly Poly make a complete and accurate disclosure of the nature and scope of such investigation. Roly Poly may obtain my credit report in connection with this application. This is my authorization to credit reporting agencies, bank(s), creditor, suppliers and Roly Poly from all liability with respect to the release of any such requested information. Authorization is granted to use photo or fax copies of my signature to obtain information. If I am requesting that Roly Poly make a credit determination based on my credit worthiness combined with any co-applicant, I authorize Roly Poly to discuss any derogatory credit items with such co-applicants. I understand that Roly Poly may, at any time, require that I sign an updated application or provide updated information. I acknowledge that I have read, and hereby agree to be bound by the Confidentiality and Non-Disclosure provisions which appear below.
Yes, I agree to the above terms and conditions.
How did you hear about us?


The individual who has signed the application ("Applicant") has applied to become a franchisee of Roly Poly ("Roly Poly") and, in connection with the application process, may become privy to certain information regarding the business of Roly Poly and its affiliates and its franchisees which Roly Poly classifies and protects as confidential and proprietary (the "Information"). Roly Poly is willing to divulge such Information (as and to the extent it deems appropriate in connection with the Applicant's application) only if the Applicant agrees to protect the confidentiality of such Information. In consideration of the disclosure of Information, Applicant agrees to the following terms and conditions.

1. Confidentiality: Applicant on behalf of itself and its affiliates, employees, officers and directors, agrees to maintain as confidential all information disclosed to it. Applicant shall not, directly or indirectly, disclose any such information to any third party without Roly Poly prior written consent.

2. Return of Information: Applicant shall return to Roly Poly within ten (10) days of written request therefore, all information, together with any and all copies thereof.

3. No Rights of Information: Neither this Agreement nor the disclosure of Information shall be deemed, by implication or otherwise, to vest in Applicant any rights in the Information or any other trade secrets or property of Roly Poly.

4. Breach: Any breach of any provision hereof will be theft of Roly Poly trade secrets, and will cause irreparable harm and damage to Roly Poly. Roly Poly shall be entitled to enjoin any actual or threatened violation of any of the provisions in this Agreement. In addition to Injunctive relief, Roly Poly may recover damages from Applicant for any loss caused by any violation of the provisions of this Agreement (including violations by third parties to whom Applicant discloses Information). In any action brought to enforce any of the provisions of this Agreement, Roly Poly shall be entitled to reasonable attorneys fees and costs.

5. Severability: Any provision hereof which may prove unenforceable under any law or by any court shall not affect the validity of any other provision hereof.